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Chapter 13Hip, Pelvis, and Thigh Injuries
The Hip, Pelvis, and Thigh
Includes some of the strongest muscles in the body.
Subjected to tremendous demands.
Extremely vulnerable to injuries that can sideline a player for an extensive period of time
Anatomy of the Hip and Pelvis
The hip joint is a ball-and-socket joint that allows motion and provides stability needed to bear body weight
The socket area, which is inside the pelvis, is called the acetabulum. The ball part of this joint is the top of the leg bone (head). It joins with the acetabulum to form the hip joint.
Anatomy of the Thigh Bones
The femur• Designed to permit
maximum mobility and support during movement
• Longest and strongest bone in the body
• Extends from the hip to the knee
• The head of femur articulates with the pelvis to form the hip joint
Anatomy of the Thigh Pelvis
Ilium Ischium Pubis
Muscles of the Hip Most powerful
in the body Hip Flexors
Rectus femoris Sartorius Iliopsoas
Psoas major Psoas minor iliacus
Muscles of the Hip
Hip Extensors Hamstrings
Biceps femoris Vastus lateralis Vastus medialis
Gluteus maximus
Muscles of the Hip Abductors
Gluteus medius
Gluteus minimus
Tensor fascia latae
Muscles of the Hip/Thigh Medial Thigh
Muscles (Groin) Primary function:
adduction Gracilis Adductor magnus Adductor brevis Adductor longus Pectineus
Thigh Injuries Very few sprained
ligaments or dislocations in this area
Proper flexibility and strength prevents most hip injuries
Proper equipment also important
Thigh Injuries
Quadriceps Contusion Symptoms & Signs
Caused by sharp blow to thigh Severe impact from relaxed thigh (muscle to
femur) Extent of force and degree of thigh relaxation
determines depth of injury Feels like a muscle bruise Produces intense pain and weakness Grades 1 - 4 depending on severity of injury
Thigh Injuries
Management RICE Use elastic bandage for pressure and support in
the quadriceps area Constant stretching of quadriceps muscle Do not exercise if pain is still occurring Begin slowly with swimming, jogging, etc...
Thigh Injuries
Myositis Ossificans (bone growth in muscle) Symptoms & Signs
Pain, muscle weakness, soreness, swelling, decreased muscle function, ROM
Caused by multiple blows to the muscle area A single severe blow Improper care of a contusion
Management PRICE Do not ignore quadriceps contusions Remove surgically after one year
Thigh Injuries
Quadriceps & Hamstring Strains Symptoms & Signs
Pain, discomfort, point tenderness, spasms, soreness Grade 1 = mostly spasms, grade 3 = rupture of
tendon/muscle tissues Strains tend to reoccur because of scar tissue that
forms during the healing process Management
PRICE, NSAIDS, analgesics Cryotherapy Preventative – stretch, warm up, use proper form
Thigh Injuries
Stress Fractures and Femur Fractures Symptoms & Signs
Stress fracture – femur bends slightly, pain and discomfort from pounding of lower extremity (running)
Femur Fracture – severe pain, loss of function, internal bleeding, swelling
Management for stress fracture: Rest An alternative activity
-Management for femur fracture: Immobilization, once at hospital traction splint may
be used to pull femur and reduce pain
Femur Fractures
Anatomy of the Hip and Pelvis
Bones Ilium
Broad, flaring portion of hip bone
Crest of the pelvis Pubis
Lower, posterior part of hip bone
Ischium Helps to form the hip
Hip injuries
Hip Pointer Injury to the iliac crest Can be as minimal as contusion or as major
as an avulsion fracture Can be very painful and debilitating
Hip Injuries/Conditions
Legg-Calve-Perthes Disease A disruption of blood flow to the head of the
femur The 'ball' of the 'ball and socket' joint dies Usually is seen in children 2 to12 years of
age, five times more common in boys than girls
Characterized by extreme pain in groin and knee area, or walking with limp
Hip Injuries
Dislocation of hip – Femur pops out of the socket (acetabulum) Causes
Athletic injuries Car accidents Severe falls
Signs & Symptoms Extreme pain Leg is often internally rotated Possible loss of feeling in foot or leg due to nerve
damage X-Ray or position of leg usually determines this
injury
Hip Injuries - Dislocation
Management Call ambulance immediately, hospital will
relocate hip Months of rehab needed – very long process Begin with normal ROM and strength May need to learn how to walk again
Hip injuries - Snapping Hip
The snapping hip – The IT band snaps over the greater trochanter hip stability becomes lessened and ligaments and adductor muscles become less stable.- Causes
Habitual movements that predispose muscles around the hip to become imbalanced
Greater range of motion of hip abduction Dancers, gymnasts, hurdlers – structurally narrow pelvic
width Signs & Symptoms
Snapping occurs when balancing on one leg Pain and inflammation with the snapping
Hip snapping
Hip injuries – Hip snapping
Management Cryotherapy Ultrasound to stretch tight muscles and
strengthen weak muscles in the hip region Resume activity when the pain subsides
Slipped Capital Femoral Epiphysis The head of the femur slips off of the
neck or shifts position Found mostly in boys between 10 -17 who are
tall & thin or obese May be related to the effects of a growth
hormone Signs & Symptoms
Pain in the groin, limping Hip and knee pain during passive and active motion
Avascular Necrosis
Temporary or permanent loss of the blood supply to the proximal femur.- Causes
Without blood, the bone tissue dies and causes a collapse of the joint surface.
Use of steroids can cause AVN
- Signs and Symptoms No symptoms in the early stages Joint pain, at first during activity, then during rest Osteoarthritis may develop after a period of time
Avascular Necrosis
Management See physician for an MRI, X-ray, or CT scan Electrical stimulation, ROM exercises, reduce
weight bearing activity Surgery will eventually be required to repair
the joint
Groin Strains and Avulsions
Groin Strains
Groin strains usually involve the adductor group (especially adductor longus) Causes
Running, jumping, or twisting with external rotation Sports that require stretching of the hip Rapid changes in speed or direction (soccer)
Signs & Symptoms Complete rupture of the muscles that attach the pelvis
bone to the femur bone. Pain, weakness, and internal hemorrhage A sudden twinge or feeling of tearing
Groin Strains
Management RICE, NSAIDs, anagelsics for 48 – 72 hours
after injury occurs Rest Daily whirlpool therapy or cryotherapy Ultrasound Gradual stretching to restore ROM Protective spica bandages can be worn or
Sawa groin & thigh braces
Hip, Thigh, and Groin Stretches
Hip, Thigh, and Groin Stretches