Thigh, Hip and Pelvis
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Transcript of Thigh, Hip and Pelvis
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Thigh, Hip and Pelvis
Joints are rarely injured in sport Soft tissue is commonly injured Bony Structure
– Femur – Pelvis– Sacrum and Coccyx
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Pelvis
Iliac Crest ASIS and PSIS Ischial tuberosity Innominate Bone- Consist of:
– Ilium– Ischium– Pubis
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Hip Joint
Ball and Socket Joint Head of the femur- Convex Acetabulum of the pelvis- Concave Highly Stable from a bony perspective; several very
strong ligaments that aid in keeping the head of femur in the acetabulum
Bursae– Iliopsoas bursa– Deep trochanteric bursa
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Nerves and Blood Supply
Nerve supply– Lumbar plexus (L1 – L4) - forms the femoral nerve– Sacral Plexus (L4 – S4) – forms the sciatic nerve
Blood supply– Femoral artery
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Muscles and Movements
Hip flexion – Normal ROM
80 degrees knee straight 120 degrees knee bent bent
– Iliacus and psoas major (major flexors)- both form the illiopsoas- knee bent
– Rectus femoris (function when knee is extended and with kicking the ball)
– Sartorius Hip Extension
– Normal ROM 10 – 20 degrees– Hamstrings, gluteus maximus
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Muscles and Movements (2)
Abduction– Normal ROM
45 degrees– Gluteus medius
Adduction– Normal ROM
30 degrees– Adductor magnus, longus, brevis, and gracilis
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Muscles and Movements (3)
Internal Rotation or Medial Rotation– Normal ROM
45 degrees– Glueteus Minimus and Tensor Fascia Latae
External Rotation or Lateral Rotation– Normal ROM
45 degrees– 6 deep external rotators- piriformis
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Quadriceps Contusions
MOI: direct blow HOPS
– Pain, swelling and ecchymosis– Walk with a limp– Palpable hematoma, with heat
Tx– Ice in stretched position, crutches if needed, wrap,
See field strategy 10.2 (pg. 352), refer for x-ray
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Myositis Ossificans
Accumulation of mineral deposits (bone) in muscle tissue MOI: Single severe blow, repeated blows to muscle,
mismanagement of contusion HOPS
– Firm swollen area in muscle– Palpable mass– Limited knee flexion– Active contraction of muscle difficult
Tx– Refer to physician (surgery may be needed)
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Hip Pointer
Contusion caused by direct compression to the iliac crest
MOI: Direct blow Hops
– Pn with rotation, trunk flexion– Ecchymosis, pain, swelling,– Point tender over illiac crest
TX– RICE, refer for x-ray, donut pad and hard outer shell, to protect
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Bursitis
Most common = trochanteric bursitis MOI: overuse HOPS:
– Deep achy pain in lateral thigh– Pn with resisted abduction
TX– Heat, stretch abductors, Ultrasound– If condition does not resolve: refer to physician
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Hip Sprains/ Dislocations
MOI: violent twisting/ severe trauma; rare in sports HOPS: S/S with degree and type
– Intense pain,– Inability to walk or move hip– Hip flexed and internally rotated – Fig 10-12
TX– Symptomatic with mild to moderate sprains– Medical emergency, summon EMS, check distal
neurovascular status; treat for shock
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Muscle Strains
Hamstring strains more probable than Quadriceps strains; Adductor strains are more common than Abductor
Hamstring Strains are most common Precursors
– muscle imbalances, tight muscles, improper warm-up, overuse, fatigue, dynamic overload
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Muscle Strains (2)
HOPS-In isolated region in question– “twinge” or “pull”– Weakness on RROM testing– Limping; Ecchymosis– Pop is heard when severe; Palpable defect– Pain with passive stretch, and resistive motion– Treatment- Hip Flexor or Hip Adductor Wrap; RICE,
E-Stim, Strengthening/Stretching, NSAID’s; crutches if necessary
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Muscle Strength Testing
5 (normal) full strength against resistance 4 (good) partial strength against resistance 3 (fair) ability to move the body part no
resistance 2 (poor) able to contract muscle 1 (trace) no evidence of contractility
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Legg-Calve-Perthes Disease
Avascular necrosis (decreased blood supply to the head of femur) of the proximal femoral epiphysis-Fig 10-13
Precursors: young males 3-8 years old HOPS:
– Gradual onset of pain in hip/groin or knee with no explanation– Gradual onset of a limp; – Decreased range of motion in the hip- AB, EX, ER
TX: refer to physician if unexplained hip, thigh or knee pain last for more than a week.
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Avulsion Fractures (1)
Precursors:– Individuals who perform rapid acceleration/
deceleration Locations:
– ASIS: Sartorius– AIIS: Rectus Femoris– Ischial tuberosity: hamstrings
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Avulsion Fractures (2)
HOPS– Sudden acute localized pain– Pain, swelling, discoloration over area– Pain with resisted stretching of the involved muscle
TX– Hip Spica Wrap if able– Fit for crutches– Refer to physician
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Slipped Femoral Epiphysis
Epiphyseal/ Growth Plate fracture- Fig 10-15 Precursor: Adolescent boys ages 8 – 15, obese or
slender rapidly growing boys HOPS:
– Painful limp– Pain in the groin, anterior thigh or knee– Unable to internally rotate femur– Unable to stand on injured leg
TX: Refer to physician, surgery
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Stress Fractures
Precursor: Box 10-3 Common locations
– Pubis– Femoral neck– Proximal 1/3 of femur
HOPS– Aching pain in groin or thigh during WB– Pn relieved by rest– Night pain
TX: Refer to physician
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RROM testing
Hip Flexion Hip Extension Hip Abduction Hip Adduction Hip Internal Rotation Hip External Rotation Knee Extension Knee flexion
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Measuring for Leg Length
ASIS Medial Malleolus Patient Position:
– Lying on table, pelvis square and balanced– Legs parallel– Heels approximately 6-8 inches apart
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Special Tests
Thomas Test = Hip flexion contractures Kendall Test = Hip flexion contractures (Rectus
Femoris) Straight Leg Raise=Disc Lesions or tight
hamstrings Pelvic Rock Test=Pelvic Fracture/SI Joint
Sprain Trendelenburg’s Test
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Specialized Rehab
SLR’s- all 4 planes Quad Sets/Glute Sets/Ham Sets Stretching Strengthening Electrical Stimulation, US, Massage