The Thigh, Hip and Pelvis

Anatomy of the pelvis

Bony and Muscular Anatomy

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Quad Contusion Cause of Injury Signs 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

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

Myositis Ossificans Traumatica Cause of Injury 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

Quadriceps Muscle Strain Cause of Injury 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

Hamstring Muscle Strains Cause 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

Hamstring Muscle Strains, cont. 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

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

Femoral Stress Fractures Cause of Injury Overuse Females who are amenorrheic are more vulnerable to stress fx Signs of Injury Persistent pain in thigh X-ray or bone scan will reveal fracture Commonly seen in femoral neck Management Analgesics, NSAID’s RICE ROM and PRE exercises are carried out w/ pain free ROM Rest, limited weight bearing

Legg-Perthes Disease (Coxa Plana) Cause of Condition Avascular necrosis of the femoral head in child age 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

Cont. Care Complication 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