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Hip, Thigh, and Knee. ILIUM Acetabulum Ischium Ischial Tuberosity Pubis.

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Presentation on theme: "Hip, Thigh, and Knee. ILIUM Acetabulum Ischium Ischial Tuberosity Pubis."— Presentation transcript:

1 Hip, Thigh, and Knee



4 Acetabulum

5 Ischium Ischial Tuberosity Pubis


7 Greater Trochanter Lesser Trochanter Lateral Condyle Medial Condyle

8 Lateral Condyle Patella

9 Posterior Cruciate Ligament Anterior Cruciate Ligament


11 Medial Meniscus Lateral Meniscus Medial Collateral Ligament Lateral Collateral Ligament

12 Anatomy Buttocks Gluteus –Medius, –Minimus, –Maximus Piriformis

13 Anatomy Hip Flexors Psoas Major, Minor Iliacus

14 Anatomy Quadriceps Rectus femoris Vastus lateralis Vastus medialis Vastus intermedius Abductor Complex Sartorius Tensor Fascia Lata Hamstrings Semimembranosus Semitendinosus Biceps femoris Adductor Complex Adductor –Brevis –Longus –Magnus Gracilis

15 Quadriceps Rectus Femoris –O: Anterior inferior iliac spine –I: Patella and Tibial Tuberosity –A: flexion of hip, knee extension

16 Vastus Lateralis –O: greater trochanter –I: lateral patella, lateral femoral condyle and rectus femoris tendon –A: extension of knee

17 Quadriceps Vastus Intermedius –O: proximal 2/3 of anterior femur –I: inferior aspect of patella and tendons of vastus lateralis and medialis –A: extension of knee

18 Vastus Medialis –O: Between the Greater and Lesser Trochanter –I: medial tibial condyle, medial patella and medial aspect of rectus femoris tendon –A: extension of knee Vastus Medialis Oblique –O: Tendon of Adductor Magnus –I: Patellar Tendon/ Tibial Tuberosity –A: stabilize patella


20 ABductors Sartorius –O: Anterior superior iliac spine –I: inferior to medial condyle of tibial –A: Flexion, Abduction, and External Rotation of hip; flexion of knee, Tensor Fascia Latae –O: Outer lip of iliac crest and between anterior superior and anterior inferior iliac spine –I: Greater trochanter of femur, and (as iliotibial band) lateral condyle of tibia –A: Abduction

21 Adductors Adductor –Longus O: pubic bone I: Middle 1/3 of Femur A: adduction –Brevis O: pubic bone I: proximal 1/3 of femur A: adduction –Magnus O: pubic bone and ischial Tuberosity I: distal 1/3 of femur A: adduction


23 Adductors Gracilis –O: pubic symphisis and pubic bone –I: distal to medial tibial condyle –A: adduction, flexion, and internal rotation of hip, flexion of knee; (Cross legs)

24 Iliopsoas O: Thorasic and Lumbar Vertebrae (front of spine) and Ilium I: Lesser Trochanter A: Flexion of hip

25 Hamstrings Biceps Femoris –O: ischial Tuberosity –I: head of fibula and lateral tibial condyle –A: extension of hip; flexion of knee



28 Hamstrings Semimembranosus –O: ischial Tuberosity –I: medial tibial condyle –A: hip extension, knee flexion Semitendinosus –O: ischial Tuberosity –I: medial condyle of tibia –A: hip extension, knee flexion T M

29 T M

30 Gluteuses Gluteus Minimus –O: Ilium –I: Anterior Greater Trochanter –A: Abducts and Internal Rotation Gluteus Medius –O: Ilium –I: Lateral Greater Trochanter –A: Abduction and Internal Rotation

31 Gluteus Maximus –O: Ilium Sacrum –I: Posterior Greater Trochanter and IT Band –A Extension and External Rotation

32 Hip/Thigh Movements Abduction Adduction Extension Flexion Internal Rotation External Rotation What muscles do these movements?

33 Palpation Hip ASIS Iliac Crests PSIS Greater Trochanter Soft Tissue IT Band

34 What muscles do these movements? List out the muscles that do each movement: Abduction Adduction Hip Flexion Hip Extension External Rotation

35 Observation Symmetry- hips, pelvis tilt (anterior/posterior) –Lordosis or flat back Lower limb alignment –Knees, patella, feet –Genu Valgum/ Genu Varum Pelvic landmarks (ASIS, PSIS, iliac crest) Standing on one leg –Pubic symphysis pain or drop on one side Ambulation –Walking, sitting - pain will result in movement distortion

36 Observation Anteversion (A) and Retroversion (B) Think in terms of the Greater Trochanter

37 Observation Leg Length Discrepancy –Anatomical Actual bone length difference –Functional Rotation of pelvis Muscle tightness –1/8 inch or greater = discrepancy

38 Special Tests Fracture Range of Motion –Passive –Active –Resistive

39 Thigh Injuries Quadriceps Contusion –Mechanism Blow to quads. –Symptoms Pain Swelling Bruising Loss of function –Treatment RICE –Ice bent position

40 The red is hemorrhaging within the compartment Increased swelling = Increased pressure = decreased healing/ function If hemorrhage gets too large will have to do a compartment release which is done by cutting the fascia to allow the expansion

41 Thigh Injuries Myositis Ossificans Myo= muscle itis = irritation oss = bone –Mechanism Blow to thigh  Hemorrhage  hematoma –Symptoms Pain - Hard “bump” Musc weakness- Swelling Loss of function –Treatment At first can use Ultrasound Surgical Removal

42 Quad Compression Wrap –Start slightly above patella –Begin just like all other ACE wrapping techniques. –Continue up the thigh halfway overlapping alternating angling up and angling down. –Practice it!

43 Thigh Injuries Hamstring Strain –Mechanism Overloading of HS muscles Over stretching –Symptoms Pain- swelling- G2 or 3 = palpate deformity Loss of function- “popping” –Treatment RIC ROM stretching Compression wrap same as Quad Contusion

44 Hip Injuries Groin Strain –Straining of Adductors –Over stretching of the muscle Symptoms –Pain in medial hip –Pain referred to knee Treatment –RIC- light stretching –NSAIDs- Strengthening –ROM exercises- Compression wrap

45 Groin wrap Start with roll on lateral side of leg Start ACE at an angle –2 times around with “dog ear” Apply extra tension going medially as to pull the leg into ADduction. Continue your spica until out of wrap. - Athlete should fee leg being pulled in and slightly forward. ****Anytime doing a hip wrap you will pull in the direction that the injured muscles does.

46 Hip Flexor Strain Rectus Femoris/ Iliopsoas Strain -Often due to explosive activities (sprinting) -Symptoms -“Pop”- Loss of function -Pain -Treatment -Light stretches- rest -Compression wrap pulling forward -strengthening

47 Hip Special Tests Kendall / Thomas test –Positioning Athlete lies supine with ½ of femur off the table –Test Athlete hugs opposite knee to chest –Positive Knee Extends = Rectus Femoris tightness Hip Flexes = Hip Flexor Contracture


49 Hip Injuries Contusion (Hip Pointer) –Mechanism Blow to iliac –Symptoms Bruising Pain Loss of function –Treatment RICE

50 IT Band IT Band Tendonitis –Mechanism Repetitive friction over greater trochanter or lateral femoral condyle Pes cavus, Genu varum –Symptoms pain at greater trochanter or lateral femoral condyle Positive Ober and Nobles tests –Treatment Stretch tendon- Ice Strengthen Abductors- Rest

51 IT Band Tightness Noble’s Test –Position – athlete supine athlete’s knee is flexed to 90 degrees –Test – Pressure is applied to lateral femoral condyle while knee is extended –Positive – Pain at lateral femoral condyle IT Band Tendinitis

52 IT Band Tightness Ober’s –Position Athlete is lying on side opposite of affected side Tester is behind the athlete at the hip –Test Tester holds ankle and knee (flexed to 90) Tester allows knee to adduct. –Positive Pain or tightness No drop of the knee

53 Gluteus Medius and Adductor Weakness Trendelenburg –Position Patient stands with feet together –Test Tester stands behind the athlete Athlete lifts knee as to march –Positive Drop in the non weight bearing side PSIS/ Iliac Crest *Weakness in these muscle groups can lead to IT band tendonitis, bursitis, and other hip problems.

54 Hip Injuries Trochanteric Bursitis –Cause Excessive repetitive irritation at Greater Trochanter –Symptoms Hip instability Snapping sensation Pain/ inability to walk –Treatment ICE- Stretching NSAIDs- Strengthening Ultrasound (not the kind you see a baby with) Compression wrap Special Test - Range of Motion reproduces the pain

55 Hip Injuries Dislocated Hip –Mechanism Result of traumatic force –Signs and Symptoms Flexed, adducted and internally rotated hip Palpation reveals displaced femoral head posteriorly Other –Soft tissue, neurological damage and possible fx –Special Tests none –Management EMERGENCY ROOM! 2 weeks immobilization and crutch use for at least one month

56 Knee Observation Patellar positioning –Alta –Baja Knee Positioning –Genu varum –Genu valgum –Genu Recurvatum Swelling –Intracapsular –Extracapsular

57 Observation Patella Alta –High Patella tight quad muscles, places extra stress on patellar tendon, causes extra friction on Femoral condyles Patella Baja –Low Patella – shorter patellar tendon, causes extra friction on Femoral condyles

58 Soft Tissue of the Knee

59 Observation Genu Varum –Bow legged –Stresses lateral structures Genu Valgum –Knock kneed –Stresses medial structures Genu Recuvatum –Hyper-extended knees

60 Meniscus and Ligaments

61 Palpation Knee Medial and Lateral Condyle Tibial Tuberosity Patella Soft Tissue Medial Collateral Ligament (MCL) Lateral Collateral Ligament (LCL) Patellar Tendon IT Band Meniscus (med & lat) Animation

62 Knee Injuries MCL or LCL sprain –Mechanism Lateral (mcl) or medial (lcl) force knee –Symptoms Pain laxity –Treatment RICE Taping

63 Knee Special Tests Valgus and Varus Stress tests –Tests MCL (Valgus) or LCL (Varus) –Positioning Athlete sitting or lying down in relaxed position –Test Apply a medial (varus) or lateral (valgus) pressure to joint line while pulling lower leg in the opposite direction Perform this at 0 degrees and 30 degrees –Positive Pain (1 st or 2 nd degree sprain) Laxity (2 nd or 3 rd degree sprain Practice it Practice it

64 Knee Injuries ACL sprain –Mechanism Plant and twist –Symptoms Joint laxity (give way) 1-2 pain Locking swelling –Treatment RICE quad strengthening Swelling control ROM SURGERY

65 Special Tests Anterior Drawer –Tests ACL –Position Athlete supine on table with knee bent to 90 degrees Tester sits on foot to stabilize lower leg Place thumbs on the tibial plateau (tibial joint line) –Test Pull lower leg anteriorly in line with thigh in a jerking motion –Positive Pain or laxity –Note: if the athlete does have an ACL injury it is likely that you will only have one chance to correctly do this test because they may guard against you after that. Practice it Practice it

66 Special Tests Lachman Drawer Test –This test is less painful and more precise after a knee injury –Position Athlete is supine on the table with legs straight Tester places their knee under femur in order to bend the knee to 30 degrees –Test Tester pulls the tibia directly upward and presses the femur downward in a jerking motion –Positive Pain (1 st and 2 nd degree tear) Laxity (2 nd and 3 rd degree tear) Practice it Practice it

67 ACL Surgery

68 Post. Cruciate Lig. sprain –Mechanism Blow to anterior tibia –Symptoms Pain Swelling Joint laxity –Treatment Strengthening RICE Surgery

69 Special Tests Posterior drawer –Tests PCL –Position Athlete supine on table with knee bent to 90 degrees Tester sits on foot to stabilize lower leg Place thumbs on the tibial plateau (tibial joint line) –Test Push lower leg posteriorly in line with thigh in a jerking motion –Positive Pain or laxity –Note: if the athlete does have an PCL injury it is likely that you will only have one chance to correctly do this test because they may guard against you after that. Practice it Practice it

70 Special Tests Posterior Sag Test (Godfrey’s test) –Positioning Athlete is supine w/ both knees flexed to 90 degrees –Test Lateral observation to see if either tibia has moved posteriorly

71 Meniscal Tears Mechanism –Cutting –Forcefully extended –Rotation Treatment –Surgery –Bracing –Strengthening –ROM Symptoms –Joint pain –locking –swelling –Loss of motion –giving way –cracking/popping

72 Meniscus and Ligaments

73 Special Tests –McMurray’s Test Used to determine displaceable meniscal tear Position –Athlete is supine on table Test –Leg is moved into flexion and extension while knee is internally and externally rotated in conjunction w/ valgus and varus stressing Positive –clicking and popping are felt Practice it Practice it

74 Special Tests A B C D

75 Apley’s Compression Test –Athlete prone –Hard downward pressure is applied w/ rotation –Positive - Pain indicates a meniscal injury Apley’s Distraction Test –Athlete prone –Traction is applied w/ rotation –Pain will occur if there is damage to the capsule or ligaments –No pain will occur if it is a meniscus tear Practice it Practice it

76 Special Tests Apley Compression

77 Meniscus Tear Surgery PVP4c&edufilter=ZfvWoTQoe9wnoR5AG PfSjA PVP4c&edufilter=ZfvWoTQoe9wnoR5AG PfSjA

78 Plica tear of the fascia under the patella Mechanism –Excessive Shock Symptoms –Snap/popping –Pain when sitting for long time Treatment –Rest –Heat –NSAIDs –Surgery

79 Special Tests Patellar Compression test –Position Athlete seated or lying in a comfortable position –Test Tester presses patella down into the femoral groove, then moves it up and down to feel for any abnormalities –Positive Pain or grinding sensation Practice it Practice it

80 Special Tests Patellar Grind Test –Position Athlete supine either seated or lying –Test Tester places Thumb web-space just above the patella Tester then asks athlete to contract their quad forcefully –Positive Pain and/or grinding. Practice it Practice it

81 –Chondromalacia or any condition associated with the patella on the femur Chondro = CartilageMalacia = softening of –Mechanism Patella not tracking within femoral groove correctly. –Signs and Symptoms Tenderness of lateral patella Swelling Dull ache in center of knee Patellar compression will elicit pain and crepitus Apprehension when patella is forced laterally –Management RICE- Tape patella to aid in tracking Stretch ITB - Strengthen Medial structures Patellofemoral Stress Syndrome

82 Knee Injuries Patella Dislocation –Mechanism Non-contact, quick forceful contraction of the lateral quads –Symptoms Deformity- slightly flexed knee Pain –Treatment Straighten leg- Splint I.C.E.- Send for x-rays Can cause damage to cartilage or fracture patella

83 Patellar subluxation Apprehension Test –Position Athlete supine and relaxed with knee extended –Test Tester places a lateral stress on the patella –Positive Athlete has pain or tightens quads in “fear” of dislocation

84 Mechanism –Begins as cartilage and develops a bony callus, enlarging the tubercle –Resolves w/ aging –Common cause = repeated avulsion of patellar tendon Signs and Symptoms –Swelling - Point tenderness –Pain w/ kneeling, jumping and running Management –Reduce stressful activity (6-12 months) –Possible casting, –ice before and after activity –Isometerics Osgood-Schlatter Disease


86 Patellar Tendinitis (Jumper’s or Kicker’s Knee) –Mechanism Jumping or kicking - placing tremendous stress and strain on patellar or quadriceps tendon Sudden or repetitive extension –Signs and Symptoms Pain and tenderness at inferior pole of patella –3 phases - 1)pain after activity, 2)pain during and after, 3)pain during and after (possibly prolonged) and may become constant –Management Ice, ultrasound, heat Exercise Patellar tendon bracing Transverse friction massage


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