Presentation is loading. Please wait.

Presentation is loading. Please wait.

Chapter 17: The Thigh, Hip, Groin, and Pelvis

Similar presentations

Presentation on theme: "Chapter 17: The Thigh, Hip, Groin, and Pelvis"— Presentation transcript:

1 Chapter 17: The Thigh, Hip, Groin, and Pelvis







8 Assessment History Observation Onset (sudden or slow?)
Previous history? Mechanism of injury? Pain description, intensity, quality, duration, type and location? Observation Postural symmetry? Size, deformity, swelling, discoloration? Skin color and texture? Is athlete in obvious pain? Is the athlete willing to move the thigh?

9 Assessment (cont’d.) Palpation
Soft tissue of the thigh (anterior, posterior, medial, lateral) should be palpated for pain and tenderness Bony palpation should also be performed to locate areas of pain/discomfort Utilize palpation to assess body symmetry

10 Assessment (cont’d.) Special Tests Thomas test Straight Leg Raise
Test for hip contractures Straight Leg Raise Test for hip extensor tightness Can also be used to assess low back or SI joint dysfunction

11 Prevention Thigh must have maximum strength, endurance, and extensibility to withstand strain Dynamic stretching programs may aid in muscle preparation for activity Strengthen programs can also help in preventing injuries Squats, lunges, leg press Core strengthening

12 Quadriceps Contusions
Cause of Injury Constantly exposed to traumatic blows Signs of Injury Pain, transitory loss of function, immediate bleeding of affected muscles Early detection and avoidance of internal bleeding are vital – increases recovery rate and prevents muscle scarring

13 Quad Contusions (cont’d.)
Care RICE and NSAID’s Crutches for more severe cases Isometric quadriceps contractions should begin as soon as tolerated Heat, massage and ultrasound to prevent myositis ossificans Padding may be worn for additional protection upon return to play

14 Myositis Ossificans Cause of Injury Signs of Injury Care
Formation of ectopic bone following repeated blunt trauma Signs of Injury X-ray shows calcium deposit 2-6 weeks following injury Pain, weakness, swelling, decreased ROM Tissue tension and point tenderness Care Treatment must be conservative May require surgical removal if too painful and restricts motion (after one year - remove too early and it may come back) If condition is recurrent it may indicate problem with blood clotting


16 Quad Strain Cause of Injury Signs of Injury Care
Sudden stretch when athlete falls on bent knee or experiences sudden contraction Associated with weakened or over constricted muscle Signs of Injury Peripheral tear causes fewer symptoms than deeper tear Pain, point tenderness, spasm, loss of function and little discoloration Complete tear may leave athlete w/ little disability and discomfort but with some deformity Care Rest, ice and compression to control internal bleeding Determine extent of injury early Neoprene sleeve may provide some added support

17 Hamstring Strain Cause of Injury Signs of Injury
Multiple theories of injury Hamstring and quad contract together Change in role from hip extender to knee flexor Fatigue, posture, leg length discrepancy, lack of flexibility, strength imbalances, Signs of Injury Muscle belly or point of attachment pain Capillary hemorrhage, pain, loss of function and possible discoloration Grade 1 - soreness during movement and point tenderness Grade 2 - partial tear, identified by sharp snap or tear, severe pain, and loss of function

18 Hamstring Strain (cont’d.)
Signs of Injury (continued) Grade 3 - Rupturing of tendinous or muscular tissue, involving major hemorrhage and disability, edema, loss of function, ecchymosis, palpable mass or gap Care RICE Restrict activity until soreness has subsided Ballistic stretching and explosive sprinting should be avoided initially

19 Acute Femoral Fractures
Cause of Injury Generally involving shaft and requiring great force Occurs in middle third due to structure and point of contact Signs of Injury Shock, pain, swelling, deformity Must be aware of bone displacement and gross deformity Loss of function Care Treat for shock, verify neurovascular status, splint before moving, reduce following X-ray Secure immediate emergency assistance and medical referral

20 Femoral Stress Fractures
Cause of Injury Overuse Uncommon injury – tends to occur in endurance athletes Females > Males Signs of Injury Pain occurs weeks after increasing workout intensity Persistent pain in thigh, groin, especially after activity Referred pain to knee X-ray or bone scan will reveal fracture Commonly seen in femoral neck Management Initial treatment involves rest While most head with conservative management, fracture may result May require surgical repair

21 Groin Strain Cause of Injury Signs of Injury
One of the more difficult problems to diagnose Often seen in early part of season due to poor strength and flexibility Occurs from running , jumping, twisting w/ hip external rotation or severe stretch Signs of Injury Sudden twinge or tearing during active movement Produce pain, weakness, and internal hemorrhaging

22 Groin Strain (cont’d.) Care
RICE, NSAID’s and analgesics for hours Determine exact muscle or muscles involved Rest is critical Restore normal ROM and strength -- provide support w/ wrap Refer to physician if severe groin pain is experienced

23 Hip Sprain Cause of Injury Signs of Injury Care
Result of violent twist due to forceful contact Force from opponent/object or trunk forced over planted foot in opposite direction Signs of Injury Signs of acute injury and inability to circumduct hip Pain in hip region, w/ hip rotation increasing pain Care X-rays or MRI should be performed to rule out fracture RICE, NSAID’s and analgesics Depending on severity, crutches may be required ROM and PRE are delayed until hip is pain free

24 Dislocated Hip Cause of Condition Signs of Injury
Traumatic Force along long axis of femur (generally with knee flexed) or by falling on the side Signs of Injury Flexed, adducted, and internally rotated thigh Head of femur is out of acetabulum Often includes fractures and damage to capsule and ligaments

25 Dislocated Hip (cont’d.)
Care Relocation (can be extremely difficult) Bed rest Months of walkers and/or crutches Complications Avascular necrosis Damage to blood vessels and sciatic nerve Posterior dislocations are likely to include muscular paralysis and ultimate degeneration of femoral head

26 Hip Labral Tears Cause of Condition Signs of Injury Care
Result of repetitive overuse (i.e. running or pivoting) May occur due to acute trauma (i.e. dislocation) Signs of Injury Often present as asymptomatic Causes clicking, locking, or catching Pain in the groin; stiffness; limited motion Care Exercises to maintain ROM, strength & stability Avoid aggravating activities NSAID’s, corticosteroids Surgical repair

27 Piriformis Syndrome Cause of Injury Signs of Injury Care
Rarely occurs in sport Result of traumatic force directed along the long axis of the femur Signs of Injury Flexed, adducted and internally rotated hip Palpation reveals displaced femoral head, posteriorly Serious pathology Soft tissue, neurological damage and possible fracture Care Immediate medical care (blood and nerve supply may be compromised) Contractures may further complicate reduction 2 weeks immobilization and crutch use for at least one month

28 Hip Problems in Adolescent Athletes
Legg Calve’-Perthes Disease (Coxa Plana) Cause of Condition Avascular necrosis of the femoral head in children ages 4-10 Articular cartilage becomes necrotic and flattens Signs of Condition Pain in groin that can be referred to the abdomen or knee Limping is also typical Varying onsets and may exhibit limited ROM


30 Legg-Calve’-Perthes Disease (cont’d.)
Care Bed rest to reduce chance of chronic condition Brace to avoid direct weight bearing Early treatment and head may reossify and revascularize Complication If not treated early, will result in ill-shaping and osteoarthritis in later life

31 Slipped Capital Femoral Epiphysis
Cause of Condition May be growth hormone related 25% of cases are seen in both hips Epiphysis slips from femoral head in backwards direction due to weakness in growth plate May occur during periods of elevated growth Signs of Condition Pain in groin that comes on over weeks or months Hip and knee pain during passive and active motion; limitations of abduction, flexion, medial rotation and a limp Management W/ minor slippage, rest and non-weight bearing may prevent further slippage Major displacement requires surgery If undetected or surgery fails severe problems will result


33 Iliac Crest Contusion Hip pointer Cause of Injury Signs of Injury Care
Contusion of iliac crest or abdominal musculature Result of direct blow Signs of Injury Pain, spasm, and transitory paralysis of soft structures Decreased rotation of trunk or thigh/hip flexion due to pain Care RICE for at least 48 hours, NSAID’s, Bed rest 1-2 days in severe cases Referral must be made, X-ray Padding should be used upon return to minimize chance of added injury

34 Osteitis Pubis Cause of Injury Signs of Injury Management
Seen in distance runners Repetitive stress on pubic symphysis and adjacent muscles Signs of Injury Chronic pain and inflammation of groin Point tenderness on pubic tubercle Pain w/ running, sit-ups and squats Management Rest, NSAID’s and gradual return to activity

35 Acute Fracture of Pelvis
Cause of Injury Result of direct blow or blunt trauma Signs of Injury Severe pain, loss of function, shock Care Immediately treat for shock Refer to physician Seriousness of injury dependent on extent of shock and possibility of internal injury

36 Pelvic Stress Fractures
Cause of injury Repetitive abnormal overused forces Signs of Injury Groin pain, w/ aching sensation in thigh that increases w/ activity and decreases w/ rest Discomfort increases with activity and subsides during rest Care Refer to physician for assessment and X-ray Rest for 2-5 months

37 Avulsion Fractures Cause of Injury Signs of Injury Care
Avulsions seen in sports w/ sudden accelerations and decelerations Pulling of tendon away and off of bony insertion Common sites include ASIS (sartorius), AIIS (rectus femoris attachment), ischial tuberosity (hamstring Signs of Injury Sudden localized pain w/ limited movement Pain, swelling, point tenderness Care Rest, limited activity and graduated exercise

Download ppt "Chapter 17: The Thigh, Hip, Groin, and Pelvis"

Similar presentations

Ads by Google