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Chapter 21 The Thigh, Hip, Groin, and Pelvis
Chapter 21
Extended Lecture Outline
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Anatomy of the Thigh
o Bones
 The thigh is the part of the leg between the hip and the knee
 Femur is the longest and strongest bone in the body – designed to permit maximum
mobility and support during movement
o Musculature (See Table 21-1)
 Anterior Thigh Muscles: Sartorius and Quadriceps Femoris group (Rectus Femoris,
Vastus Lateralis, Vastus Medialis, and Vastus Intermedius)
 Posterior Thigh Muscles: Popliteus and Hamstrings (Biceps Femoris, Semitendinosus,
and Semimembranosus)
 Medial Thigh Muscles (Groin): Adductor Magnus, Adductor Longus, Adductor Brevis,
Pectineus and Gracilis
o Nerve Supply (See Table 21-1 and Figure 21-14)
 Sciatic Nerve supplies the muscles of the thigh and lower leg
 Tibial and Common Peroneal nerves form the largest nerve in the body, the greater
sciatic nerve
o Blood Supply
 Main arteries that supply the thigh are the medial circumflex femoral, deep femoral, and
femoral artery
 Two main veins are the superficial great saphenous and the femoral vein
o Fascia
 Fascia lata femoris part of the deep fascia that invests the thigh musculature
Functional Anatomy of the Thigh
 Quadriceps inserts by a common tendon to the proximal patella
 Rectus Femoris is the only quadriceps muscle to cross the hip
 Hamstrings cross the knee joint posteriorly and all cross the hip except the short head of
the biceps femoris
 Position of the hip and the knee during the MOI provide important information for
rehabilitation
Assessment of the Thigh
o History
o Observation
o Palpation
o Special Tests
Prevention of Injuries to the Thigh, Hip, Groin, and Pelvic Region
 Maintain strength and flexibility of the muscles of the hip, thigh and pelvis
 Focus on dynamic stretching of quads, hamstrings and groin muscles
 Strengthening exercises should include squats, lunges and leg presses as well as a variety
of core exercises
Recognition and Management of Thigh Injuries
o Quadriceps Contusion
 Grade 1: No restriction of range of motion
 Grade 2: Inability to flex the knee more than 90º
 Grade 3: Knee flexion ROM is 90º - 45º
 Grade 4: Knee flexion ROM limited to 45º or less
o Myositis Ossificans Traumatica
 A single severe blow
 Many blows to a muscle area
 Improper care of a contusion
 Attempts to “run off” a quad contusion
 Too – vigorous treatment (massage, ultrasound or superficial heat to the contused area)
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Chapter 21 The Thigh, Hip, Groin, and Pelvis
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Quadriceps Muscle Strains (Grade 1, 2, and 3)
Hamstring Muscle Strains (Grade 1, 2 and 3)
Femoral Fractures
 Hip is usually externally rotated, slightly adducted and may appear shortened
o Femoral Stress Fractures
Anatomy of the Hip, Groin, and Pelvic Region
o Bones
 Pelvic girdle is a bony ring formed by the two innominate bones (ilium, ischium and
pubis), the sacrum and the coccyx
 Functions of the Pelvis
 Support the spine and trunk and to transfer their weight to the lower limbs
 Serves as place of attachment for trunk and thigh muscles
 Protects the pelvic viscera
o Articulations
 Sacroiliac joint and Coccyx (SI joint discussed in Chapter 25)
 Hip Joint formed by femur articulating with the acetabulum
o Ligaments, Joint Capsule, and Synovial Membrane
 Surrounding the acetabular rim is the glenoid labrum
 Capsule is reinforced by the iliofemoral, pubocapsular, and ischiocapsular ligaments
 Hyaline cartilage covers the femoral head, except for the fovea capitis
 Ligamentum teres (attaches to the fovea capitis) – function is to transport nutrients to the
head of the femur
 Ligaments reinforce the hip joint
 Iliofemoral Ligament (Y ligament of Bigelow): strongest ligament in the body – prevents
hyperextension, controls external rotation and adduction of the thigh and limits the pelvis
during backward rolling of the femoral head during weight bearing
 Pubofemoral Ligament: Prevents excessive abduction of the thigh
 Ischiofemoral Ligament: Prevents excessive internal rotation and adduction of the thigh
o Hip Musculature (See Table 21-2)
 Anterior Hip Muscles: Iliacus, Psoas Major and Minor
 Posterior Hip Muscles: Tensor Fasciae Latae, Gluteus Maximus, Medius and Minimus,
and the external rotators (Piriformis, Superior Gemellus, Inferior Gemellus, Obturator
Internus, Obturator Externus and Quadratus Femoris)
o Bursae
 Iliopsoas Bursa
 Deep Trochanteric Bursa
o Nerve Supply (See Chapter 25)
 Femoral nerve emerges from the lumbar plexus, later divides into many branches
supplying the thigh and lower leg
 Sacral Plexus: nerve fibers from 4th and 5th lumbar nerves and the first, second and third
sacral nerves
 Tibial and common peroneal nerves emerge from the sacral plexus to form the sciatic
nerve in the thigh
o Blood Supply
 Arteries: Aorta divides into two common iliac arteries, divide and then turn into the
internal and external iliac arteries (internal iliac supplies blood to pelvic viscera, external
Iliac supplies the lower limb)
 Veins: Common Iliac Vein, Internal Iliac Vein, and the External Iliac Vein
Functional Anatomy of the Hip, Groin, and Pelvic Region
 The Pelvis moves in three directions:
 Anteroposterior Tilting: Iliopsoas, other hip flexors and lumbar spine extensors tilt pelvis
anteriorly; gluteus maximus, hamstrings, rectus abdominis, and obliques tilt pelvis
posteriorly
 Lateral tilting: Hip abductors or adductors
 Rotation in transverse plane: Gluteal muscles, external rotators, adductors, pectineus and
iliopsoas act together
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Chapter 21 The Thigh, Hip, Groin, and Pelvis
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 Hip joint is a true ball-in-socket joint
 In normal gait, hip joint moves in all three planes
 Forces at the hip are 5 times body weight with running
Assessment of the Hip, Groin, and Pelvis
o History
o Observation
 Postural Asymmetry
 Standing on one leg
 Ambulation
o Palpation
o Special Tests
 Functional Evaluation (AROM, PROM, and MMT’s)
 Tests for Hip Flexor Tightness
 Kendall Test (Figure 21-15)
 Thomas Test (Figure 21-17)
 Femoral Anteversion and Retroversion
 Normal angle of the femoral neck = 15º
 Walking Toed-in may reflect femoral anteversion, Toed-out = femoral
retroversion
 Internal rotation in excess of 35º is characteristic of femoral anteversion,
external rotation in excess of 45º = femoral retroversion
 Tests for the Hip and Sacroiliac Joint
 Patrick Test (FABER) (Figure 21-19)
 Gaenslen’s Test (Figure 21-20)
 Testing for Tensor Fasciae Latae and Iliotibial Band
 Renne’s Test (Figure 21-21)
 Nobel’s Test (Figure 21-22)
 Ober’s Test (Figure 21-23)
 Other Hip Tests
 Trendelenburg’s Test: Weakness in gluteus medius (Figure 21-24)
 Piriformis Test (Figure 21-25)
 Ely’s Test: Tightness of rectus femoris (Figure 21-26)
 Measuring Leg Length Discrepancy
 True or Anatomical Discrepancy: measure between medial malleoli and ASIS
 Apparent or Functional Discrepancy: Umbilicus to the medial malleoli of each
ankle
Recognition and Management of Specific Hip, Groin, and Pelvic Injuries
o Hip Joint
 Adductor/Hip Flexor Strain (Groin Strain)
 Trochanteric Bursitis
 Sprains of the Hip Joint
 Dislocated Hip Joint
 Avascular Necrosis
o Hip Joint Problems in the Young Athlete
 Legg-Calve-Perthes Disease (Coxa Plana)
 Slipped Capital Femoral Epiphysis
 Snapping Hip
 Pelvic Conditions
 Contusion (Hip Pointer)
 Osteitis Pubis
 Athletic Pubalgia
 Stress Fractures
 Avulsion Fractures and Apophysitis
Thigh and Hip Rehabilitation Techniques
o General Body Conditioning
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Chapter 21 The Thigh, Hip, Groin, and Pelvis
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Flexibility (Figure 21-35)
Mobilizations (Figure 21-36)
 Inferior femoral glides at 90º of hip flexion – increase abduction and flexion
 Posterior femoral glide at 90º – increase hip flexion
 Anterior femoral glide – increase hip extension
 Medial femoral rotation – increase medial rotation
Strength
 (Figure 21-37) shows the various strengthening exercises for the muscles of the hip and
thigh
 Core stabilization training program is an important component of hip and pelvic
rehabilitation (Figure 21-38)
Neuromuscular Control
 Established by the appropriate combination of postural alignment and stability strength
 Focus on balance and closed kinetic chain exercises (lunge, single leg squat, theraband
walk)
 Use of balance shoes have been used to activate the lumbo-pelvic-hip musculature,
especially gluteus maximus and gluteus medius (Figure 21-40)
Functional Progressions
Return to Activity
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