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Anatomy & Injuries to the Thigh, Hip and Pelvis SP Sports Medicine John Hardin Instructor.

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Presentation on theme: "Anatomy & Injuries to the Thigh, Hip and Pelvis SP Sports Medicine John Hardin Instructor."— Presentation transcript:

1 Anatomy & Injuries to the Thigh, Hip and Pelvis SP Sports Medicine John Hardin Instructor

2 General Information about the pelvis This area of body is strong and stable This area of body is strong and stable Great demand placed on this part of body— ”core” Great demand placed on this part of body— ”core” Functions: Functions: support the spine & trunk support the spine & trunk Transfer weight to lower extremities Transfer weight to lower extremities Place for muscle attachment of thigh and trunk Place for muscle attachment of thigh and trunk Protect organs of pelvic region Protect organs of pelvic region

3 Anatomy Bones Bones Muscles Muscles Ligaments Ligaments

4 Bones Femur Femur Head, neck, greater trochanter, lesser trochanter, shaft, medial & lateral condyle and epicondyles Head, neck, greater trochanter, lesser trochanter, shaft, medial & lateral condyle and epicondyles Pelvis Pelvis Ilium: iliac crest, ASIS, AIIS, PSIS Ilium: iliac crest, ASIS, AIIS, PSIS Ishcium: ischial tuberosity Ishcium: ischial tuberosity Pubis: Pubic symphysis Pubis: Pubic symphysis Acetabulum Acetabulum

5 Bones-the anterior femur

6 The posterior femur

7 The pelvis

8 Muscles Hip Flexors: Hip Flexors: Iliacus & psoas major= Iliopsoas Iliacus & psoas major= Iliopsoas Rectus femoris Rectus femoris Sartorius Sartorius Hip Extensors: Hip Extensors: Hamstrings-biceps femoris, semitendinosus, semimembranosus Hamstrings-biceps femoris, semitendinosus, semimembranosus Gluteus maximus Gluteus maximus

9 Muscles Knee flexors: Knee flexors: Hamstrings, gastrocnemius Hamstrings, gastrocnemius Knee extensors: Knee extensors: Quadriceps—rectus femoris, vastus lateralis, vastus medialis, vastus intermedius Quadriceps—rectus femoris, vastus lateralis, vastus medialis, vastus intermedius

10 Muscles

11 Muscles

12 Muscles

13 Muscles Hip Adductors: Hip Adductors: Adductor magnus, adductor longus, adductor brevis, gracilis, pectineus Adductor magnus, adductor longus, adductor brevis, gracilis, pectineus Hip Abductors: Hip Abductors: Gluteus medius, tensor fascia latae Gluteus medius, tensor fascia latae

14 Muscles

15 Muscles

16 Muscles Hip Internal rotators: Hip Internal rotators: Tensor fascia latae, gluteus minimus Tensor fascia latae, gluteus minimus Hip External rotators: Hip External rotators: Gluteus maximus, gluteus medius, piriformis Gluteus maximus, gluteus medius, piriformis

17 Ligaments Thickening of joint capsule allows for very stable joint Thickening of joint capsule allows for very stable joint Iliofemoral Iliofemoral Ischiofemoral Ischiofemoral pubofemoral pubofemoral Ligamentum Teres Ligamentum Teres Also called the round ligament Also called the round ligament Attaches head of femur into acetabulum allowing blood supply to that area Attaches head of femur into acetabulum allowing blood supply to that area

18 Ligaments

19 Preventing injuries to thigh/hip Flexibility training and stretching Flexibility training and stretching Strength training Strength training Proper protective equipment Proper protective equipment

20 Common Injuries Strains Strains Sprains Sprains Contusions Contusions Fractures Fractures Dislocations Dislocations

21 Strains Quads Quads Hamstrings Hamstrings Groin (adductors) Groin (adductors) Hip flexors Hip flexors Gluteals Gluteals

22 Strains Mxn: Mxn: sudden strong contraction of muscle(s) sudden strong contraction of muscle(s) overstretching of muscle(s) overstretching of muscle(s) Muscle strength imbalance Muscle strength imbalance

23 Strains-hamstring

24 Strains- groin

25 Strains S/S: pain/discomfort S/S: pain/discomfort POT POT Bleeding causing discoloration (after 1-2 days) Bleeding causing discoloration (after 1-2 days) Loss of function Loss of function Muscle spasm Muscle spasm deformity deformity

26 Strains TX: RICE TX: RICE modify/restrict activity modify/restrict activity crutches if necessary crutches if necessary Medical referral if necessary Medical referral if necessary Restore normal ROM flexibility and strength using various modalities as needed Restore normal ROM flexibility and strength using various modalities as needed

27 Strains Complications: Complications: recurrent strains due to “inelasticity of scar tissue” especially at that same site recurrent strains due to “inelasticity of scar tissue” especially at that same site Excess buildup of scar tissue Excess buildup of scar tissue

28 Strains-quad after the fact

29 Strains-quad

30 Strains-hamstring

31 Strains-hamstring

32 Hamstring strain treatment

33 Hamstring avulsion

34 Contusions Quadriceps Quadriceps Hip pointer Hip pointer

35 Quadriceps Contusion Mxn: Mxn: direct blow to relaxed thigh compressing the musculature again the femur direct blow to relaxed thigh compressing the musculature again the femur

36 Quadriceps Contusion S/S: S/S: Pain Pain POT POT Bleeding into the muscle Bleeding into the muscle Swelling Swelling Temporary loss of function Temporary loss of function

37 Quad contusion Tx: RICE w/ knee flexed Tx: RICE w/ knee flexed Crutches if necessary Crutches if necessary Restore normal ROM, flexibility & strength Restore normal ROM, flexibility & strength Ultrasound Ultrasound Heat Heat Medical referral if needed Medical referral if needed

38 Quad contusion Complication: Complication: Myositis ossificans—formation of bony tissue within the muscle Myositis ossificans—formation of bony tissue within the muscle Very painful Very painful Greatly restricts ROM mainly flexion Greatly restricts ROM mainly flexion Caused by: Caused by: severe blow that is not properly cares for severe blow that is not properly cares for Repeated blows to same area Repeated blows to same area

39 Myositis Ossificans

40 Hip Pointer Mxn: Mxn: direct blow to the iliac crest and/or ASIS direct blow to the iliac crest and/or ASIS

41 S/S: S/S: Pain Pain Spasm Spasm Bleeding in the area—discloration Bleeding in the area—discloration Temporary loss of motion Temporary loss of motion Unable to rotate trunk or flex hip without pain Unable to rotate trunk or flex hip without pain

42 Hip Pointer

43 Tx: Tx: RICE RICE Bed rest if necessary Bed rest if necessary Medical referral if necessary Medical referral if necessary Return to activity when pain if gone and motion is restored Return to activity when pain if gone and motion is restored

44 Fractures-Avulsion Most common at ASIS or Ischial Tuberosity Most common at ASIS or Ischial Tuberosity Mxn: forceful contraction of muscle Mxn: forceful contraction of muscle

45 Avulsion Fractures S/S: S/S: Extreme pain with movement & weight bearing Extreme pain with movement & weight bearing POT (either over the ASIS or Ischial tub.) POT (either over the ASIS or Ischial tub.) Bleeding/discoloration Bleeding/discoloration

46 Avulsion TX: TX: Ice Ice crutches crutches Medical referral for x-ray Medical referral for x-ray

47 Fractures- femur Occurs most often in the shaft of the femur Occurs most often in the shaft of the femur Mxn: Mxn: great force-direct or indirect- placed on the femur great force-direct or indirect- placed on the femur

48 Femur Fractures S/S: S/S: Pain Pain POT POT Deformity w/ thigh externally rotated, shortened Deformity w/ thigh externally rotated, shortened Loss of motion/function Loss of motion/function Swelling due to internal bleeding Swelling due to internal bleeding Muscle spasms Muscle spasms Muscle lacerations Muscle lacerations

49 Femur fractures Can be life threatening—fatty tissue and bone marrow can get into the blood stream and cause a blood clot Can be life threatening—fatty tissue and bone marrow can get into the blood stream and cause a blood clot

50 Femur Fracture Tx: Tx: Call 911 Call 911 Don’t move the athlete Don’t move the athlete Hare traction splint Hare traction splint Check for distal pulse Check for distal pulse Control any external bleeding Control any external bleeding Treat for shock Treat for shock

51 Femur fractures

52

53 Femoral Stress Fracture Mxn: repetitive stress of the pounding of the lower extremity which causes the femur to bend (one side is compressed the other is stretched) Mxn: repetitive stress of the pounding of the lower extremity which causes the femur to bend (one side is compressed the other is stretched)

54 Femoral stress fracture S/S: S/S: POT at one specific site POT at one specific site Pain with activity Pain with activity Pain with a compressive force at the site (sitting on edge of table) Pain with a compressive force at the site (sitting on edge of table) Pain with activity Pain with activity

55 Femoral Stress fracture Tx: Tx: Rest Rest Alternate activity—non-weight bearing Alternate activity—non-weight bearing Crutches if limping Crutches if limping Medical referral---x-rays and bone scan or-- Medical referral---x-rays and bone scan or--

56 Femoral stress fx

57 Slipped Capital Femoral Epiphysis Growth plate injury (epiphyseal fracture) Growth plate injury (epiphyseal fracture) Occurs at the capital femoral epiphysis (where neck joins the head of femur) Occurs at the capital femoral epiphysis (where neck joins the head of femur) More common in boys yrs. More common in boys yrs. Tall and thin Tall and thin obese obese

58 Slipped Capital femoral epiphysis Mxn: Mxn: Not know but may be related to effects of a growth hormone Not know but may be related to effects of a growth hormone In ¼ of cases both hips are affected In ¼ of cases both hips are affected

59 Slipped---epiphysis S/S: S/S: Pain in groin area that Pain in groin area that arises suddenly as a result of trauma arises suddenly as a result of trauma arises slowly over weeks or months as a result of prolonged stress arises slowly over weeks or months as a result of prolonged stress Early signs minimal but later get pain in hip and knee Early signs minimal but later get pain in hip and knee Major limitations with movement Major limitations with movement Limp when walking Limp when walking

60 Slipped --- epiphysis TX: TX: Minor cases Minor cases Rest Rest Non-weight bearing to prevent further slippage Non-weight bearing to prevent further slippage Medical referral Medical referral Major cases Major cases Surgery to repair “fracture” usually put pins into bone to keep in place and allow for proper healing Surgery to repair “fracture” usually put pins into bone to keep in place and allow for proper healing

61 Slipped---epiphysis Complications: Complications: If displacement goes undetected or if surgery fails to restore normal hip mechanics can have problems later in life If displacement goes undetected or if surgery fails to restore normal hip mechanics can have problems later in life Bone doesn’t grow properly Bone doesn’t grow properly Head of femur doesn’t grow properly Head of femur doesn’t grow properly Bone spurs Bone spurs Arthritis Arthritis

62 SCFE

63 SCFE

64 SCFE Pins to fix Pins to fix

65 Legg-Calve-Perthes Disease Disruption of blood flow to the head of femur causing the bone tissue to die and become flattened Disruption of blood flow to the head of femur causing the bone tissue to die and become flattened Occurs in children 3-12 yrs Occurs in children 3-12 yrs Occurs in boys 4 times more often than girls Occurs in boys 4 times more often than girls Usually occurs in first born Usually occurs in first born Affect usually only one hip Affect usually only one hip

66 LCPD Mxn: Unknown Mxn: Unknown S/S: S/S: complaints of pain in groin, and sometimes referred pain to abdomen or knee complaints of pain in groin, and sometimes referred pain to abdomen or knee Limited hip movement Limited hip movement

67 LCPD Tx: Tx: Medical referral Medical referral Bed rest or non-weight bearing Bed rest or non-weight bearing If treated in time, the head of femur will revascularize and regain its normal shape (the old cells that die will be resorbed and new bone cells laid down to take their place) If treated in time, the head of femur will revascularize and regain its normal shape (the old cells that die will be resorbed and new bone cells laid down to take their place)

68 LCPD

69 LCPD Complications: Complications: If not treated early enough, the head of femur will be ill (abnormally) shaped producing osteoarthritis in later life If not treated early enough, the head of femur will be ill (abnormally) shaped producing osteoarthritis in later life

70 Hip Dislocation Rarely occurs in sports Rarely occurs in sports Most are posterior Most are posterior Mxn: traumatic force along the long axis of the femur such as falling on one side with the knee bent (and landing on that bent knee) forcing head of femur posteriorly Mxn: traumatic force along the long axis of the femur such as falling on one side with the knee bent (and landing on that bent knee) forcing head of femur posteriorly

71 Hip Dislocation S/S: S/S: Hip in flexion, adduction, and internal rotation Hip in flexion, adduction, and internal rotation Deformity posterior—head of femur can be palpated through gluteal muscle Deformity posterior—head of femur can be palpated through gluteal muscle Extreme pain Extreme pain Inability to move at hip joint Inability to move at hip joint

72 Hip Dislocation

73

74 TX: TX: Call 911 Call 911 Don’t move athlete Don’t move athlete Splint in position you find them Splint in position you find them Treat for shock Treat for shock

75 Hip Dislocation Complications: Complications: Tears in the vascular and nerve structures Tears in the vascular and nerve structures Blood vessels to ligamentum teres may be torn (as will the ligament itself) Blood vessels to ligamentum teres may be torn (as will the ligament itself) Sciatic nerve may be damaged Sciatic nerve may be damaged Paralysis of muscles in the area Paralysis of muscles in the area Atrophic necrosis (degeneration of femoral head) Atrophic necrosis (degeneration of femoral head)


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