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Chapter 14
Injuries to the Hip and Pelvis
In Your Notebooks:
• How many joints does the hip have?
Anatomy Review
Primary hip structures
• Innominate bones
• Ilium
• Ischium
• Pubis
Anatomy Review (cont.)
Functions of the pelvis include:
•
•
•
•
Attachment of lower extremities.
Protection of internal organs.
Muscle attachments.
Birth process, in females.
Joints (other than hip)
• Sacroiliac
• Pubic symphysis
Nervous System
Major Nerves
• Femoral
• Sciatic
• Obturator (not
shown)
• Saphenous
• Tibial
• Peroneal
• Plantar nerves (not
shown)
• Digital nerves
Circulatory System
Major Blood Vessels
• External iliac
• Femoral
• Deep profunda
femoral (not shown)
• Saphenous vein
• Popliteal
• Anterior tibial
• Posterior tibial
• Dorsalis pedis
• Plantar
Hip Muscles Actions:
• Hip Flexion- Rectus Femoris, Iliopsoas
group, Tensor Fascia Lata, Sartorius
• Hip Extension: Gluteals & Hamstrings
• Hip Adduction: Adductors, Pectineus and
Gracillis
• Hip Abduction: Gluteals & Tensor Fascia
Lata
Musculature (cont.)
Anterior Muscles
• Psoas major &
minor
• Iliacus
• Pectineus
• Adductors –
magnus, longus,
brevis
Musculature (cont.)
Anterior Muscles
(continued)
• Gracilis
• Tensor fascia
latae
• Quadriceps –
vastus muscles,
rectus femoris
Musculature
Posterior Muscles
• Gluteals – maximus,
medius, minimus
• Deep external
rotators – piriformis,
gemelli, obturators,
quadratus femoris
• Hamstrings – biceps
femoris,
semitendinosus,
semimembranosus
3
Hip Flexors
3
3
2
1
4
Hip
Extensors
2
2
1
Hip Adductors
1
2
3
Hip Abductors
1
1
2. Tensor
Fascia
Lata
In Your Notebooks:
• List a function of the pelvis.
Hip Anatomy Questions
1. Name the 3 main bones of the hip.
2. What are the 3 joints that make up the hip?
3. What are the 4 main functions of the hip?
4. List: - the 4 motions of the hip
- the muscles that perform each motion
- where those muscles are located
1. Name the 3 main bones of the hip.
2. What are the 3 joints that make up the hip?
3. What are the 4 main functions of the hip?
4. What are the 4 motions of the hip?
5. List the muscles that perform each motion
6. Where are each of these muscle groups
located?
In Your Notebooks:
• List an injury of the hip region.
In Your Notebooks:
• List the Signs and Symptoms of a Pelvic
Fracture.
What Injury do you think this is??
Common Sports Injuries: Skeletal
Injuries
Fractures of the Pelvis
• Pelvic fractures are devastating injuries.
• Pelvic fractures are not common in sports,
because it typically takes a great deal of
force to fracture the pelvis.
• This injury may occur in sports such as
hockey, pole-vault, or football.
• Pelvic fractures in the adolescent can be
serious.
Fractures of the Pelvis (cont.)
Signs and symptoms include:
• Abnormal pain in pelvic region.
• Swelling at the injury site, usually
accompanied with visual or palpable
deformity.
• Pain elicited when iliac crests are pressed
together.
• Injury to internal organ(s) may be
associated with this injury.
Fractures of the Pelvis (cont.)
First Aid
• Treat for shock and internal bleeding.
• Monitor vital signs.
• Arrange for transportation to a medical facility
on a spine board, elevated at the feet.
An athlete with suspected pelvic fracture should not
be allowed to return to participation before
obtaining a physician’s approval.
Adolescent Pelvic Fractures
Femoral Neck Stress Fracture
• Commonly occurs in amenorrheic athletes
involved in endurance sports.
• Result of a loss in shock-absorbing capacity
of fatigued hip muscle
• Or poor footwear,hard running surface or hip
deformities
• Athlete complains of severe anterior thigh or
groin pain and experiences pain when
walking.
Slipped Capital Femoral Epiphysis
• Commonly occurs in prepubescent boys, particularly
tall boys who experienced recent growth spurts,
overweight boys, and late-maturing boys.
• Exhibits flexed hip,lack of hip motion,pain in ant.
Groin,hip/knee
What about
this one??
Hip Pointer
Hip Pointer is a common injury, involving a
contusion to the anterior/superior portion of
the iliac crest.
• Although extremely painful and debilitating,
it does not require immediate medical
attention.
• Signs and symptoms include swelling,
pain, and discoloration at injury site.
• Athlete may walk with slight limp.
Hip Pointer (cont.)
First Aid
• Apply ice immediately.
• Athlete should rest and avoid activities
involving lower extremities.
• In severe cases, crutches may be
necessary.
• Permit limited participation within 1 to 2
weeks.
Hip Pointer (cont.)
Pad the area to
avoid recurrence.
Courtesy of Brent Mangus
What injury could this
be?
Osteitis Pubis
• This injury results from constant stress and
possibly some degeneration in the pubic
symphysis joint.
• Long distance runners, basketball players,
and any athlete experiencing repetitive
loading of this area is vulnerable.
• Male athletes may have testicular or scrotal
pain, along with discomfort in the anterior
pubic, suprapubic, or hip areas.
Osteitis Pubis (cont.)
First Aid
• Refer to a physician.
• Condition often responds well to rest, ice,
and over-the-counter anti-inflammatory
medications.
• It may take 3 months to a year to recover.
What Injury is this?
Hip Dislocation
Dislocated Hip
• This serious injury is rare in athletics, but it
may occur in contact/collision sports.
• Injury can occur from a violent collision
such as seen in tackle football or ice
hockey.
• The mechanism of injury: The hip is in
flexion and force is applied through the
femur.
Hip Dislocation (cont.)
Signs and symptoms include:
• Generally posterior dislocation.
• Pain and loss of movement in affected leg.
• Swelling that is palpable.
• Knee of the involved leg is angled toward the
opposite leg.
First Aid
• Treat for shock.
• Immobilize the athlete and contact EMS.
• Monitor blood flow to the lower leg at all times.
Any Guesses??
Avulsion Fractures of the Hip
In an avulsion fracture, a bone fragment is
torn away with tendon attached.
• Avulsion fractures of the hip are
uncommon but can occur—the ischial
tuberosity and pubis are likely sites of
this injury.
• Injury likely to occur while sprinting or
jumping.
• More common in Adolescents
Avulsion Fractures of the Hip
(cont.)
Signs and symptoms include:
• Pain and swelling at site of injury.
• Inability to use the muscle group involved
due to avulsion.
• Point tenderness over injury.
• Snapping or popping sensation at the time
of injury.
Avulsion Fractures of the Hip
(cont.)
First Aid
• Immediately apply ice.
• Have athlete rest.
• Limit athlete’s movements. Crutches may
be necessary for walking.
• Refer to a physician for evaluation.
In Your Notebooks:
• What is a Hip Pointer?
• What is an Avulsion Fracture?
• What position would an athlete be in if they
dislocated their hip?
• What joint does Osteititis Pubis affect?
• Who is most likely to get a Femoral Neck
Stress Fracture?
• Who is most likely to get a slipped capital
femoral epiphysis?
Injuries to Male Genitalia
These injuries are usually transient (short) in
nature.
• Scrotal trauma can cause testicular
contusion.
• Severe trauma can rupture testicle.
Wearing a protective cup is advised in
collision/contact sports.
Testicular or Scrotal Contusions
Signs and symptoms include:
• Extreme pain & point tenderness.
• Assuming fetal position and grasping testicles.
• Athlete’s report of a blow to the testicles.
First Aid
• Apply ice, and allow athlete to rest lying down.
• In cases of swelling or pain lasting longer than a
few minutes, refer to a physician.
• Testicular torsion (twisting) can occur and results
in considerable discomfort. Transport to medical
care facility.
Nerve Problems
A common complaint is burning or tingling
sensation radiating from the hip to buttocks
area and going down the leg.
• This discomfort often results from sciatic
nerve irritation.
• Continuing to participate in the activity
aggravates the irritation.
• Refer athlete to a physician.
• Rest, stretching, and strengthening exercises
may be helpful.
Hernias
A hernia is a protrusion of viscera through
abdominal wall.
• Inguinal hernia is more common in males
• Femoral hernia is more common in females.
• Athlete should seek the advice of a physician
regarding surgical options.
• In a sports hernia, the posterior inguinal wall
is weakened without protrusion of abdominal
contents. No palpable hernia is detected, but
athlete complains of pain in groin and lower
abdominal areas.
• http://www.youtube.com/watch?v=JXn4NggR
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Prevention
• Many hip injuries can be prevented through
proper conditioning and strengthening of the
associated musculature.
• Rest is also important for the body to repair
micro damages incurred by the stresses of
training.
• Protective equipment and proper footwear
may also help to prevent injuries from
occurring.