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The Hip Sports Med 2.

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Presentation on theme: "The Hip Sports Med 2."— Presentation transcript:

1 The Hip Sports Med 2

2 The Hip A ball and socket joint
Hip transmits the load from the foot to the spine and vice versa

3 Blood & Nerve Supply Femoral artery Common Iliac Vein Femoral Nerve
Sciatic Nerve Largest nerve in the body Innervates thigh and lower leg

4 Bursae Iliopsoas and deep trochanteric bursae Most important ones

5 Injury Trochanteric Bursitis MOI:
Common at the greater trochanter, high in women w/ increased Q angle, or leg length discrepancy Inflammation of bursa, or insertion of gluteus medius, or IT band S/S: c/o pain on lateral hip Radiating pain down to the knee Tenderness over greater trochanter TX: PRICE, NSAIDS, ROM, PREs, no inclined running Special Tests: Obers,

6 Ober’s Test Athlete lays on unaffected side Knee flexed at 90 degrees
Lift top leg into abduction, slight hip extension Allow the affected leg to drop into adduction If leg does NOT drop = + tight IT band

7 Bones Sacrum, Coccyx Pelvis Ilium, Ischium, Pubis
Innominate bones: ossify and fuse early in life Pelvis Support the spine and trunk Transfer their weight to the lower limbs Placement for bony attachment Ilium, Ischium, Pubis Make up pelvis

8 Injuries Hip Pointer (contusion) MOI S/S TX
blow to inadequately protected iliac crest Most handicapping injury in sports, difficult to manage S/S Immediate pain, spasms, transitory paralysis of soft structures Unable to rotate the trunk or to flex the thigh with out pn TX RICE, referral, x-ray, ice massage, ultrasound, injection Doughnut pad for return to play

9 Hip dislocation

10 Injuries Hip Dislocation pg 727 fig. 21-30 MOI S/S TX
Rarely occur during sports Femur is adducted and flexed S/S Flexed, adducted, and internally rotated thigh Deformity, nerve damage TX Immobilization, ice, analgesics

11 Injury Avulsion Fracture MOI:
Most common: 1) ischial tuberosity (hamstrings), 2)AIIS(rectus femoris), ASIS (sartorius) Sudden acceleration/deceleration S/S: Sudden local pain Limited movement TX: X ray, PRICE, crutches, ROM, PREs Special Tests: Hip MMTs

12 Injury Osteitis Pubis MOI:
Seen in running sports (XC, football, soccer, wrestling Repetitive stress on pubis symphysis by surrounding muscles S/S: Groin pain while running, squats, sit ups TX: rest, oral antiinflammatory agents, gradual return to play Special Tests: running, sit up, squats

13 Articulations Sacroiliac Joint Joint Capsule Hip Joint
Supported by ligaments Connects sacrum to ilium Joint Capsule The acetabulum is cushioned by the labrum Hip Joint Made of femur head and acetabulum Padded at the center by a mass of fatty tissue, ligaments and capsule

14 Ligaments Iliofemoral Pubofemoral Y ligament of Bigelow
Strongest ligament of body Prevents hyperextension Pubofemoral Prevents excessive abduction

15 Ligaments Ischiofemoral Ligamentum Teres
Prevents internal rotation and adduction On posterior aspect Ligamentum Teres Ligament to the head of the femur A bridge to allow blood vessels and nerves to enter the head of the femur

16 Injuries Hip Sprain MOI S/S TX
Strong, therefore best protected, seldom injured Violent twisting produced by opponent, foot firmly planted and trunk forced in opposing direction S/S Athlete is unable to circumduct the thigh pain TX X-rays to rule out fx RICE, analgesics, limit wt. bearing, pain free ROM Special Tests: active circumduction of thigh, IR, ER

17 Injuries Sacroiliac Joint Sprain (S.I. Joint) MOI S/S TX
Twists with both feet on the ground Stumbles forward, falls backward, steps in hole S/S Pain over joint, muscle guarding, radiating pain down back of gluteus and hamstring Asymmetrical ASIS/PSIS or leg length difference TX Modalities, brace, stability exercises Special Test: FABERS/Patricks

18 FABERs /Patrick Test Procedure: Place foot on the opposite extended knee of the painful SI joint Apply pressure downward on the bent knee. Positive test: Pain felt in hip or SI jt. = SI joint dysfunction

19 Muscles Anterior Iliacus Psoas (major and minor) Sartorius
Triangular shaped, flexes the hip Psoas (major and minor) Flexes the hip Sartorius Crosses medially across the anterior aspect of the thigh Hip flexion, and external rotation Rectus Femoris Hip flexion and knee extension

20 Muscles Lateral Posterior Tensor fascia latae 3 gluteal muscles
Hip abduction Posterior 3 gluteal muscles Gluteus Maximus: extension, adduction, helps us get up from a sitting position Gluteus Medius: abduction Gluteus Minimus: abduction Hamstrings: hip extension, knee flexion Biceps Femoris, Semitendinosis, Semimembranosus

21 Muscles Medial All act as adductors and rotators of the hip Gracilis
Adducts, flexes, external rotation Pectineus Adducts, flexes, external rotation Adductor longus, brevis and magnus Adducts, external rotation

22 Injuries Groin Strain (adductor/Hip flexor strain) Special Tests: MMTs
MOI The groin is the area between the thigh and the abdominals Torn during twist or pull while running or jumping S/S Felt as sudden twinge or feeling of tearing during an AROM, or may feel it the next day Pain, weakness, internal bleeding TX PRICE, analgesics, ROM and strengthening exercises Rest has been the best treatment, protective spica Special Tests: MMTs

23 Thomas Test Procedure: Athletes lies supine legs together
ATC places on hand under athletes lumbar curve One thigh is brought to the chest flattening the spine. Return bent leg to extended position, lumbar curve should return. Positive Test: Extended thigh should be flat on the table, if not = tight hip flexor

24 Kendall test Procedure: Athlete lies supine with knees off table
Athlete brings one leg to their chest Positive Test: If thigh comes off the table = tight hip flexor

25 Injury Quad Contusion MOI TX: flx w/ice pack ,PRICE,NSAIDS, crutches
Direct blow to the thigh TX: flx w/ice pack ,PRICE,NSAIDS, crutches Grade 1 Superficial bruise Mild hemorrhage, mild pain, no swelling, mild pt tenderness No game restrictions Grade 2 deeper Pain, swelling, cannot flex knee more then 90 degrees Grade 3 Moderate pain and swelling, limping, cannot flex knee Severe/Grade 4 Disability, may split the fasciae Severe pain, limited ROM, limp

26 Injury Myositis Ossificans Traumatica MOI: S/S: TX: Special Tests:
Severe blow or repeated blows to thigh, usually the quadriceps Can lead to ectopic bone production (myosositis ossificans) S/S: Pain, swelling, decreased function TX: Conservative, surgery one year later Special Tests: AROM knee flexion/ext

27 Injury Hamstring Strain MOI S/S TX Special test: MMTs
Most common injury to thigh, exact cause is not known Possible MOI: muscle fatigue, faulty posture, leg length discrepancy, tight hamstrings S/S Hemorrhage, pain, loss of function. 3 grades of strain TX PRICE, NSAIDS, very conservative, PREs Special test: MMTs

28 Hamstring MMT

29 Injury Snapping Hip: MOI: S/S: TX:
Excessive repetitive movement in dancers, gymnasts, hurdlers, sprinters MOI: Imbalance in muscle IT band moves over the greater trochanter S/S: c/o of snapping with pain TX: Ice, NSAIDS, ultrasound, then stretching

30 Trendelenburg’s test Procedure: Athlete stands, foot on the unaffected side is lifted Look at the iliac crest to see if it stays level Positive test: if unaffected side is lowers OR If standing on leg and affected hip moves into abduction = Weak abductors

31 Measuring for Leg length
2 main ways: Anatomical discrepancy Functional discrepancy

32 Anatomical discrepancy (true method)
ASIS (actual bone is shortened) Athlete lies supine with legs straight Measurement is taken between the medial malleoli and ASIS Bilaterally compare Malleoli

33 Functional discrepancy
Due to pelvic tilt or deformity Athlete lies supine, legs straight Measurement is taken from umbilicus to the medial malleoli Bilaterally compare

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