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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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Presentation on theme: "Thigh, Hip and Pelvis Joints are rarely injured in sport Soft tissue is commonly injured Bony Structure – Femur – Pelvis – Sacrum and Coccyx."— Presentation transcript:

1 Thigh, Hip and Pelvis Joints are rarely injured in sport Soft tissue is commonly injured Bony Structure – Femur – Pelvis – Sacrum and Coccyx

2 Pelvis Iliac Crest ASIS and PSIS Ischial tuberosity Innominate Bone- Consist of: – Ilium – Ischium – Pubis

3 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

4 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

5 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

6 Muscles and Movements (2) Abduction – Normal ROM 45 degrees – Gluteus medius Adduction – Normal ROM 30 degrees – Adductor magnus, longus, brevis, and gracilis

7 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

8 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

9 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)

10 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

11 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

12 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 TX – Symptomatic with mild to moderate sprains – Medical emergency, summon EMS, check distal neurovascular status; treat for shock

13 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

14 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

15 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

16 Legg-Calve-Perthes Disease Avascular necrosis (decreased blood supply to the head of femur) of the proximal femoral epiphysis-Fig 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.

17 Avulsion Fractures (1) Precursors: – Individuals who perform rapid acceleration/ deceleration Locations: – ASIS: Sartorius – AIIS: Rectus Femoris – Ischial tuberosity: hamstrings

18 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

19 Slipped Femoral Epiphysis Epiphyseal/ Growth Plate fracture- Fig 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

20 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

21 RROM testing Hip Flexion Hip Extension Hip Abduction Hip Adduction Hip Internal Rotation Hip External Rotation Knee Extension Knee flexion

22 Measuring for Leg Length ASIS Medial Malleolus Patient Position: – Lying on table, pelvis square and balanced – Legs parallel – Heels approximately 6-8 inches apart

23 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

24 Specialized Rehab SLR’s- all 4 planes Quad Sets/Glute Sets/Ham Sets Stretching Strengthening Electrical Stimulation, US, Massage


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