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The HipThe Hip
A ball and socket jointA ball and socket joint Hip transmits the load Hip transmits the load
from the foot to the from the foot to the spine and vice versaspine and vice versa
Blood & Nerve SupplyBlood & Nerve Supply
Femoral arteryFemoral artery Common Iliac VeinCommon Iliac Vein Femoral NerveFemoral Nerve Sciatic NerveSciatic Nerve
Largest nerve in the bodyLargest nerve in the body Innervates thigh and lower legInnervates thigh and lower leg
BursaeBursae
Iliopsoas and deep trochanteric bursaeIliopsoas and deep trochanteric bursae Most important onesMost important ones
InjuryInjury
Trochanteric BursitisTrochanteric Bursitis MOI:MOI:
• Common at the greater trochanter, high in women w/ increased Q Common at the greater trochanter, high in women w/ increased Q angle, or leg length discrepancyangle, or leg length discrepancy
• Inflammation of bursa, or insertion of gluteus medius, or IT bandInflammation of bursa, or insertion of gluteus medius, or IT band S/S:S/S:
• c/o pain on lateral hipc/o pain on lateral hip• Radiating pain down to the kneeRadiating pain down to the knee• Tenderness over greater trochanterTenderness over greater trochanter
TX:TX:• PRICE, NSAIDS, ROM, PREs, no inclined runningPRICE, NSAIDS, ROM, PREs, no inclined running
Special Tests: Obers, Special Tests: Obers,
Ober’s TestOber’s Test-Athlete lays on unaffected Athlete lays on unaffected sideside-Knee flexed at 90 degreesKnee flexed at 90 degrees-Lift top leg into abduction, Lift top leg into abduction, slight hip extensionslight hip extension-Allow the affected leg to Allow the affected leg to drop into adductiondrop into adduction
-If leg does NOT drop = + If leg does NOT drop = + tight IT band tight IT band
BonesBones Sacrum, CoccyxSacrum, Coccyx
Innominate bones: Innominate bones: ossify and fuse early in ossify and fuse early in lifelife
PelvisPelvis Support the spine and Support the spine and
trunk trunk Transfer their weight Transfer their weight
to the lower limbsto the lower limbs Placement for bony Placement for bony
attachmentattachment Ilium, Ischium, PubisIlium, Ischium, Pubis
Make up pelvisMake up pelvis
InjuriesInjuries
Hip Pointer (contusion)Hip Pointer (contusion) MOIMOI
• blow to inadequately protected iliac crestblow to inadequately protected iliac crest• Most handicapping injury in sports, difficult to manageMost handicapping injury in sports, difficult to manage
S/SS/S• Immediate pain, spasms, transitory paralysis of soft Immediate pain, spasms, transitory paralysis of soft
structuresstructures• Unable to rotate the trunk or to flex the thigh with out pnUnable to rotate the trunk or to flex the thigh with out pn
TXTX• RICE, referral, x-ray, ice massage, ultrasound, injectionRICE, referral, x-ray, ice massage, ultrasound, injection• Doughnut pad for return to playDoughnut pad for return to play
InjuriesInjuries
Hip Dislocation pg 727 fig. 21-30Hip Dislocation pg 727 fig. 21-30 MOIMOI
• Rarely occur during sportsRarely occur during sports• Femur is adducted and flexedFemur is adducted and flexed
S/SS/S• Flexed, adducted, and internally rotated thighFlexed, adducted, and internally rotated thigh• Deformity, nerve damageDeformity, nerve damage
TXTX• Immobilization, ice, analgesicsImmobilization, ice, analgesics
InjuryInjury Avulsion FractureAvulsion Fracture
MOI:MOI:
• Most common: 1) ischial Most common: 1) ischial tuberosity (hamstrings), tuberosity (hamstrings), 2)AIIS(rectus femoris), ASIS 2)AIIS(rectus femoris), ASIS (sartorius)(sartorius)
• Sudden acceleration/decelerationSudden acceleration/deceleration S/S:S/S:
• Sudden local pain Sudden local pain
• Limited movementLimited movement TX:TX:
• X ray, PRICE, crutches, ROM, X ray, PRICE, crutches, ROM, PREsPREs
Special Tests: Hip MMTsSpecial Tests: Hip MMTs
InjuryInjury Osteitis PubisOsteitis Pubis
MOI:MOI:• Seen in running sports (XC, Seen in running sports (XC,
football, soccer, wrestlingfootball, soccer, wrestling• Repetitive stress on pubis Repetitive stress on pubis
symphysis by surrounding symphysis by surrounding musclesmuscles
S/S:S/S:• Groin pain while running, squats, Groin pain while running, squats,
sit upssit ups TX: rest, oral antiinflammatory TX: rest, oral antiinflammatory
agents, gradual return to playagents, gradual return to play Special Tests: running, sit up, squatsSpecial Tests: running, sit up, squats
ArticulationsArticulations Sacroiliac JointSacroiliac Joint
Supported by ligamentsSupported by ligaments Connects sacrum to iliumConnects sacrum to ilium
Joint CapsuleJoint Capsule The acetabulum is The acetabulum is
cushioned by the labrumcushioned by the labrum
Hip JointHip Joint Made of femur head and Made of femur head and
acetabulumacetabulum Padded at the center by a Padded at the center by a
mass of fatty tissue, mass of fatty tissue, ligaments and capsuleligaments and capsule
LigamentsLigaments
IliofemoralIliofemoral Y ligament of BigelowY ligament of Bigelow Strongest ligament of Strongest ligament of
bodybody Prevents hyperextensionPrevents hyperextension
PubofemoralPubofemoral Prevents excessive Prevents excessive
abductionabduction
LigamentsLigaments
IschiofemoralIschiofemoral Prevents internal Prevents internal
rotation and adductionrotation and adduction On posterior aspectOn posterior aspect
Ligamentum TeresLigamentum Teres Ligament to the head Ligament to the head
of the femurof the femur A bridge to allow blood A bridge to allow blood
vessels and nerves to vessels and nerves to enter the head of the enter the head of the femurfemur
InjuriesInjuries Hip SprainHip Sprain
MOIMOI• Strong, therefore best protected, seldom injuredStrong, therefore best protected, seldom injured
• Violent twisting produced by opponent, foot firmly Violent twisting produced by opponent, foot firmly planted and trunk forced in opposing directionplanted and trunk forced in opposing direction
S/SS/S• Athlete is unable to circumduct the thighAthlete is unable to circumduct the thigh
• painpain TXTX
• X-rays to rule out fxX-rays to rule out fx
• RICE, analgesics, limit wt. bearing, pain free ROMRICE, analgesics, limit wt. bearing, pain free ROM Special Tests: active circumduction of thigh, IR, Special Tests: active circumduction of thigh, IR,
ERER
InjuriesInjuries Sacroiliac Joint Sprain (S.I. Joint)Sacroiliac Joint Sprain (S.I. Joint)
MOIMOI• Twists with both feet on the groundTwists with both feet on the ground
• Stumbles forward, falls backward, steps in holeStumbles forward, falls backward, steps in hole S/SS/S
• Pain over joint, muscle guarding, radiating pain down Pain over joint, muscle guarding, radiating pain down back of gluteus and hamstringback of gluteus and hamstring
• Asymmetrical ASIS/PSIS or leg length differenceAsymmetrical ASIS/PSIS or leg length difference TXTX
• Modalities, brace, stability exercisesModalities, brace, stability exercises Special Test: FABERS/PatricksSpecial Test: FABERS/Patricks
FABERs /Patrick TestFABERs /Patrick Test
Procedure: Place foot on Procedure: Place foot on the opposite extended knee the opposite extended knee of the painful SI jointof the painful SI joint
Apply pressure downward Apply pressure downward on the bent knee.on the bent knee.
Positive test: Pain felt in hip Positive test: Pain felt in hip or SI jt. = SI joint or SI jt. = SI joint dysfunctiondysfunction
MusclesMuscles AnteriorAnterior
IliacusIliacus• Triangular shaped, flexes the hipTriangular shaped, flexes the hip
Psoas (major and minor)Psoas (major and minor)• Flexes the hipFlexes the hip
SartoriusSartorius• Crosses medially across the Crosses medially across the anterior aspect of the thighanterior aspect of the thigh• Hip flexion, and external Hip flexion, and external rotationrotation
Rectus FemorisRectus Femoris• Hip flexion and knee extensionHip flexion and knee extension
MusclesMuscles LateralLateral
Tensor fascia lataeTensor fascia latae• Hip abductionHip abduction
PosteriorPosterior 3 gluteal muscles3 gluteal muscles
• Gluteus Maximus: extension, Gluteus Maximus: extension, adduction, helps us get up fromadduction, helps us get up froma sitting positiona sitting position• Gluteus Medius: abductionGluteus Medius: abduction• Gluteus Minimus: abductionGluteus Minimus: abduction
Hamstrings: hip extension, knee flexionHamstrings: hip extension, knee flexion• Biceps Femoris, Semitendinosis, SemimembranosusBiceps Femoris, Semitendinosis, Semimembranosus
MusclesMuscles Medial Medial
All act as adductors and All act as adductors and rotators of the hiprotators of the hip GracilisGracilis
• Adducts, flexes, external Adducts, flexes, external rotationrotation
PectineusPectineus• Adducts, flexes, external rotationAdducts, flexes, external rotation
Adductor longus, brevis and Adductor longus, brevis and magnusmagnus• Adducts, external rotationAdducts, external rotation
InjuriesInjuries Groin Strain (adductor/Hip flexor strain)Groin Strain (adductor/Hip flexor strain)
MOIMOI• The groin is the area between the thigh and the abdominalsThe groin is the area between the thigh and the abdominals• Torn during twist or pull while running or jumpingTorn during twist or pull while running or jumping
S/SS/S• Felt as sudden twinge or feeling of tearing during an AROM, or Felt as sudden twinge or feeling of tearing during an AROM, or
may feel it the next daymay feel it the next day• Pain, weakness, internal bleedingPain, weakness, internal bleeding
TXTX• PRICE, analgesics, ROM and strengthening exercisesPRICE, analgesics, ROM and strengthening exercises• Rest has been the best treatment, protective spicaRest has been the best treatment, protective spica
Special Tests: MMTsSpecial Tests: MMTs
Thomas TestThomas Test
Procedure: Athletes lies supine Procedure: Athletes lies supine legs togetherlegs together
ATC places on hand under ATC places on hand under athletes lumbar curveathletes lumbar curve
One thigh is brought to the One thigh is brought to the chest flattening the spine.chest flattening the spine.
Return bent leg to extended Return bent leg to extended position, lumbar curve should position, lumbar curve should return. return.
Positive Test: Extended thigh Positive Test: Extended thigh should be flat on the table, if should be flat on the table, if not = tight hip flexornot = tight hip flexor
Kendall testKendall testProcedure: Athlete Procedure: Athlete lies supine with lies supine with knees off tableknees off table
Athlete brings one Athlete brings one leg to their chestleg to their chest
Positive Test: If Positive Test: If thigh comes off the thigh comes off the table = tight hip table = tight hip flexorflexor
InjuryInjury Quad ContusionQuad Contusion
MOIMOI• Direct blow to the thighDirect blow to the thigh
TX: flx w/ice pack ,PRICE,NSAIDS, crutchesTX: flx w/ice pack ,PRICE,NSAIDS, crutches
InjuryInjury
Myositis Ossificans TraumaticaMyositis Ossificans Traumatica MOI:MOI:
• Severe blow or repeated blows to thigh, usually the Severe blow or repeated blows to thigh, usually the quadricepsquadriceps
• Can lead to ectopic bone production (myosositis Can lead to ectopic bone production (myosositis ossificans)ossificans)
S/S:S/S:• Pain, swelling, decreased functionPain, swelling, decreased function
TX:TX:• Conservative, surgery one year laterConservative, surgery one year later
Special Tests:Special Tests:• AROM knee flexion/extAROM knee flexion/ext
InjuryInjury Hamstring StrainHamstring Strain
MOIMOI• Most common injury to thigh, exact cause is not Most common injury to thigh, exact cause is not
knownknown• Possible MOI: muscle fatigue, faulty posture, leg Possible MOI: muscle fatigue, faulty posture, leg
length discrepancy, tight hamstringslength discrepancy, tight hamstrings S/SS/S
• Hemorrhage, pain, loss of function. Hemorrhage, pain, loss of function. • 3 grades of strain3 grades of strain
TXTX• PRICE, NSAIDS, very conservative, PREsPRICE, NSAIDS, very conservative, PREs
Special test: MMTsSpecial test: MMTs
InjuryInjury Snapping Hip:Snapping Hip: Excessive repetitive movement in dancers, gymnasts, Excessive repetitive movement in dancers, gymnasts,
hurdlers, sprintershurdlers, sprinters MOI:MOI:
• Imbalance in muscleImbalance in muscle• IT band moves over the greater trochanterIT band moves over the greater trochanter
S/S:S/S:• c/o of snapping with painc/o of snapping with pain
TX:TX:• Ice, NSAIDS, ultrasound, then stretchingIce, NSAIDS, ultrasound, then stretching
Trendelenburg’s testTrendelenburg’s test
Procedure: Athlete stands, Procedure: Athlete stands, foot on the unaffected side foot on the unaffected side is liftedis lifted
Look at the iliac crest to Look at the iliac crest to see if it stays levelsee if it stays level
Positive test: if unaffected Positive test: if unaffected side is lowers side is lowers
OROR
If standing on leg and If standing on leg and affected hip moves into affected hip moves into abductionabduction
= Weak abductors= Weak abductors
Measuring for Leg lengthMeasuring for Leg length
2 main ways:2 main ways: Anatomical Anatomical
discrepancydiscrepancy Functional Functional
discrepancydiscrepancy
Anatomical Anatomical discrepancydiscrepancy(true method)(true method)
((actual bone is actual bone is shortened)shortened)
Athlete lies supine with Athlete lies supine with legs straightlegs straight
Measurement is taken Measurement is taken between the medial between the medial malleoli and ASIS malleoli and ASIS
Bilaterally compareBilaterally compare
Functional Functional discrepancydiscrepancy
Due to pelvic tilt or Due to pelvic tilt or deformitydeformity
Athlete lies supine, legs Athlete lies supine, legs straightstraight
Measurement is taken Measurement is taken from umbilicus to the from umbilicus to the medial malleoli medial malleoli
Bilaterally compareBilaterally compare