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

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Presentation on theme: "The Hip Sports Med 2. The Hip  A ball and socket joint  Hip transmits the load from the foot to the spine and vice versa."— 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 Largest nerve in the body Innervates thigh and lower leg Innervates thigh and lower leg

4 Bursae  Iliopsoas and deep trochanteric bursae Most important ones Most important ones

5 Injury  Trochanteric Bursitis MOI: MOI: Common at the greater trochanter, high in women w/ increased Q angle, or leg length discrepancyCommon 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 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,

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

8 Injuries  Hip Pointer (contusion) MOI MOI 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/S S/S Immediate pain, spasms, transitory paralysis of soft structuresImmediate pain, spasms, transitory paralysis of soft structures 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 TX TX 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

9 Hip dislocation

10 Injuries  Hip Dislocation pg 727 fig MOI MOI Rarely occur during sportsRarely occur during sports Femur is adducted and flexedFemur is adducted and flexed S/S S/S Flexed, adducted, and internally rotated thighFlexed, adducted, and internally rotated thigh Deformity, nerve damageDeformity, nerve damage TX TX Immobilization, ice, analgesicsImmobilization, ice, analgesics

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

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

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

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

15 Ligaments  Ischiofemoral Prevents internal rotation and adduction Prevents internal rotation and adduction On posterior aspect On posterior aspect  Ligamentum Teres Ligament to the head of the femur Ligament to the head of the femur A bridge to allow blood vessels and nerves to enter 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 MOI Strong, therefore best protected, seldom injuredStrong, therefore best protected, seldom injured Violent twisting produced by opponent, foot firmly planted and trunk forced in opposing directionViolent twisting produced by opponent, foot firmly planted and trunk forced in opposing direction S/S S/S Athlete is unable to circumduct the thighAthlete is unable to circumduct the thigh painpain TX TX 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, ER Special Tests: active circumduction of thigh, IR, ER

17 Injuries  Sacroiliac Joint Sprain (S.I. Joint) MOI MOI 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/S S/S Pain over joint, muscle guarding, radiating pain down back of gluteus and hamstringPain over joint, muscle guarding, radiating pain down back of gluteus and hamstring Asymmetrical ASIS/PSIS or leg length differenceAsymmetrical ASIS/PSIS or leg length difference TX TX Modalities, brace, stability exercisesModalities, brace, stability exercises Special Test: FABERS/Patricks 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 Iliacus Triangular shaped, flexes the hipTriangular shaped, flexes the hip Psoas (major and minor) Psoas (major and minor) Flexes the hipFlexes the hip Sartorius Sartorius Crosses medially across theCrosses medially across the anterior aspect of the thigh Hip flexion, and externalHip flexion, and externalrotation Rectus Femoris Rectus Femoris Hip flexion and knee extensionHip flexion and knee extension

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

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

22 Injuries  Groin Strain (adductor/Hip flexor strain) MOI MOI 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/S S/S Felt as sudden twinge or feeling of tearing during an AROM, or may feel it the next dayFelt as sudden twinge or feeling of tearing during an AROM, or may feel it the next day Pain, weakness, internal bleedingPain, weakness, internal bleeding TX TX 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: MMTs 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 MOI Direct blow to the thighDirect blow to the thigh TX: flx w/ice pack,PRICE,NSAIDS, crutches 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: MOI: Severe blow or repeated blows to thigh, usually the quadricepsSevere blow or repeated blows to thigh, usually the quadriceps Can lead to ectopic bone production (myosositis ossificans)Can lead to ectopic bone production (myosositis 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/ext AROM knee flexion/ext

27 Injury  Hamstring Strain MOI MOI Most common injury to thigh, exact cause is not knownMost common injury to thigh, exact cause is not known Possible MOI: muscle fatigue, faulty posture, leg length discrepancy, tight hamstringsPossible MOI: muscle fatigue, faulty posture, leg length discrepancy, tight hamstrings S/S S/S Hemorrhage, pain, loss of function.Hemorrhage, pain, loss of function. 3 grades of strain3 grades of strain TX TX PRICE, NSAIDS, very conservative, PREsPRICE, NSAIDS, very conservative, PREs Special test: MMTs Special test: MMTs

28 Hamstring MMT

29 Injury  Snapping Hip:  Excessive repetitive movement in dancers, gymnasts, hurdlers, 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

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 Anatomical discrepancy Functional discrepancy Functional discrepancy

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

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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