Auburn High School Sports Medicine Source: Hoppenfeld, Chapter 6 Hip and Pelvis Evaluation

BIG IDEAS At the end of this unit, you will know that: The position and movement of the pelvis directly affects the low back. The knee movers also cross the hip joint and act on it. Pelvic tilt is almost more important that femur movement. The hip is the 2 nd most mobile joint and, therefore, one of the least stable. The hip muscles produce most of the force involved in many athletic skills, specially rotation.

Hip and Pelvis Anatomy BONES Pelvic = Pubis + Ischium + Ilium Femur Sacrum Coccyx

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© 2009 McGraw-Hill Higher Education. All rights reserved. Figure 21-10

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Hip and Pelvis Anatomy (cont.) JOINTS Sacroiliac Hip joint Pubic Symphysis * * *

Hip and Pelvis Anatomy (cont.) MUSCLES Flexors – Where do they have to be located? Illiopsoas Sartorius Rectus Femoris Extensors – Where are they? Gluteus Maximus Hamstrings = Semitendinosis, Semimembranosus, Biceps Femoris

© 2009 McGraw-Hill Higher Education. All rights reserved. Figure 21-2 * * * * * * * * * ***

Hip and Pelvis Anatomy (cont.) Muscles (Cont) Abductors –What side are they on? Gluteus Medius Tensor Fascia Latae Adductors – Where do their ends attach? Pectineus Adductor magnus Adductor brevis Adductor longus Gracilis

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Hip and Pelvis Anatomy (cont.) LIGAMENTS Inguinal Ligament Iliofemoral Ischiosfemoral Pubofemoral

Hip and Pelvis Anatomy (cont.) NERVES Femoral Nerve (anterior) Sciatic Nerve (posterior)

© 2009 McGraw-Hill Higher Education. All rights reserved. Figure A

Hip and Pelvis Anatomy (cont.) BLOOD SUPPLY Femoral Artery Femoral Vein

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Hip and Pelvis Anatomy (cont.) BURSAE Trochanteric Bursa

Hip Evaluation-HISTORY Can you remember the 5 basic questions? Think about the Hip anatomy. What are some additional questions that are important?

Hip Evaluation- OBSERVATION Gait Pattern Symmetry-Stance and Alignment Bilateral Comparison for: Swelling Discoloration Deformity

Hip Evaluation-PALPATION BONY Anterior Superior Iliac Spine (ASIS) = __________________ Iliac Crest = ____________________________________ Posterior Superior Iliac Spine (PSIS) = _________________ Greater Trochanter = ____________________________ Ischial Tuberosity = ___________________________ S-I joint = ___________________________________ Lumbar Spinous Processes = _______________________ Pubic Tubercle * = _______________________________

Hip Evaluation-PALPATION (cont) SOFT TISSUE Femoral Triangle BORDERS: Inguinal Ligament Sartorius Adductor Longus INSIDE THE TRIANGLE: Femoral Artery Femoral Vein Lymph Nodes *Femoral Nerve*

Hip Evaluation-PALPATION (cont) SOFT TISSUE (cont) Trochanteric Bursa

Hip Evaluation-PALPATION (cont) SOFT TISSUE (cont) Gluteus Medius Tensor Fasciae Latae Sciatic Nerve Iliopsoas Rectus Femoris Gracilis Pectineus Adductor Brevis Longus Adductor Magnus Gluteus Maximus Hamstrings = Biceps Femoris, Semimembranosus, Semitendinosus

Hip Evaluation- STRESS TESTS AND ROM Passive, Active and Resistive Range of Motion- Can you think of all 6 actions that the hip joint can perform? 1. _____________ 2. _____________ 3. _____________ 4. _____________ 5. _____________ 6. _____________ APPLICATION QUESTIONS: When doing passive hip flexion, what structures are you testing? When doing active hip flexion, what structures are you testing? How does hip flexion range of motion testing change if you bend the knee and do it?

Hip Evaluation- STRESS TESTS AND ROM Dermatomes

Hip Evaluation- STRESS TESTS AND ROM Trendelenberg Test How to: ________ What it tests for: __ Positive sign: _______ Abductor weakness (glut med)

Hip Evaluation- STRESS TESTS AND ROM True Leg Length (B) How to: ________ What it tests for: _________ Positive sign: _______

Hip Evaluation- STRESS TESTS AND ROM Apparent Leg Length (C) How to: ________ What it tests for: _________ Positive sign: _______

Hip Evaluation- STRESS TESTS AND ROM Ober Test How to: ________ What it tests for: _________ Positive sign: _______

Hip Evaluation- STRESS TESTS AND ROM Thomas Test How to: ________ What it tests for: _________ Positive sign: _______ Kendall Test How to: ________ What it tests for: _________ Positive sign: _______

Functional Testing What can you do to have an athlete test the function of his/her hip? (at least 5) How should you order those functional tests?

LAST STEP REFER TO A PHYSICIAN!!!

Hip and Pelvis Injuries

Thigh Injuries Quadriceps Contusion Etiology: _______________ Signs/Symptoms: ___________________ Management: ____________________ **Myositis Ossificans = ________________

Thigh Injuries (cont) Quadriceps Strain Mechanism(s): _____________________ Signs/Symptoms: _______________________ Hamstring Strain Mechanism(s): _____________________ Signs/Symptoms: _______________________ *Grade 1 = ______________ *Grade 2 = ______________ *Grade 3 = ______________

Strains (cont.) Management = _______________________________

Thigh Injuries (cont) Femur Fractures Acute Fracture Etiology = ______________________ Common location = __________________ Treatment = __________________ Severity = ________________ Stress Fracture Etiology = ___________________ Signs/Symptoms = ______________________ Management = ______________________

Thigh Injuries (cont) Groin Strain (adductor/flexor) Etiology = ______________ Management = RICE = NSAIDs = Pain-free ROM

Thigh Injuries (cont) Trochanteric Bursitis Where? ________________ Why? ________________ Determine through palpation and IT Band tests Management: RICE NSAIDs Phonophoresis *Note Q-Angle* = ______________________________

Thigh Injuries (cont) OTHERS: Sprains of the Hip Joint Hip Dislocation Avascular Necrosis = ________________________

Hip Injuries Avulsion Fractures = ___________________________ Apophysitis = ________________________ Hip Pointer Contusion to Iliac Crest or Abdominal Muscles Osteitis Pubis Inflammation of Pubic Symphysis due to ________________