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Anatomy & Injuries to the Thigh, Hip and Pelvis

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Presentation on theme: "Anatomy & Injuries to the Thigh, Hip and Pelvis"— 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 Great demand placed on this part of body—”core” Functions: support the spine & trunk Transfer weight to lower extremities Place for muscle attachment of thigh and trunk Protect organs of pelvic region

3 Anatomy Bones Muscles Ligaments

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

5 Bones-the anterior femur

6 The posterior femur

7 The pelvis

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

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

10 Muscles

11 Muscles

12 Muscles

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

14 Muscles

15 Muscles

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

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

18 Ligaments

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

20 Common Injuries Strains Sprains Contusions Fractures Dislocations

21 Strains Quads Hamstrings Groin (adductors) Hip flexors Gluteals

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

23 Strains-hamstring

24 Strains- groin

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

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

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

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

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

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

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

39 Myositis Ossificans

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

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

42 Hip Pointer

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

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

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

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

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

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

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

51 Femur fractures

52 Femur fractures

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)

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

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

56 Femoral stress fx

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

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

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

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

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



64 SCFE 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 Occurs in children 3-12 yrs Occurs in boys 4 times more often than girls Usually occurs in first born Affect usually only one hip

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

67 LCPD Tx: Medical referral 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)


69 LCPD Complications: 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 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

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

72 Hip Dislocation

73 Hip Dislocation

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

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

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