1. © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher Education. All rights reserved.

9. Prevention of Thigh Injuries Thigh must have ____________, ___________, and ________ to withstand _______ ____________________ may aid in muscle preparation for activity _____________ can also help in preventing injuries –____________________

10. © 2007 McGraw-Hill Higher Education. All rights reserved. Recognition and Management of Thigh Injuries Quadriceps Contusions –Cause of Injury Constantly exposed to _______________ –Signs and Symptoms Pain, ______________, ______________ of affected muscles ___________ and ________________ are vital – increases ____________ and prevents _____________

11. © 2007 McGraw-Hill Higher Education. All rights reserved. Treatment –_________________ –Crutches for more severe cases –Isometric quadriceps contractions should begin as soon as tolerated –_________________ _________________ _________________ –Padding may be worn for additional protection upon return to play

12. © 2007 McGraw-Hill Higher Education. All rights reserved. Myositis Ossificans –Cause of Injury _________________________________________ _______________ –Signs and Symptoms X-ray shows ___________________ following injury Pain, weakness, swelling, decreased ROM _____________ and __________________ –Treatment Treatment must be _______________ May require __________________ and _______ _____ (after one year - remove too early and it may come back) If condition is recurrent it may indicate problem with ___________

13. © 2007 McGraw-Hill Higher Education. All rights reserved.

14. Quadriceps Strain –Cause of Injury ____________ when athlete falls on _______ or experiences _______________ Associated with _________________________________ –Signs and Symptoms ___________ causes fewer symptoms than ___________ Pain, point tenderness, spasm, loss of function and little discoloration ____________ may leave athlete w/ little _________ and ____________ but with some ____________ –Treatment Rest, ice and compression to control internal bleeding ________________________ Neoprene sleeve may provide some added support

15. © 2007 McGraw-Hill Higher Education. All rights reserved. Hamstring Strains –Cause of Injury Multiple theories of injury –________________________________ –Change in role from ________________________ –_________________________________________ _________________________________________ –Signs and Symptoms __________________________________ Capillary hemorrhage, pain, ______________ and _________________________ –Grade 1 - __________________ and point tenderness –Grade 2 - ___________________________________ ___________________________________________

16. © 2007 McGraw-Hill Higher Education. All rights reserved. –Signs of Injury (continued) –Grade 3 - __________ of tendinous or muscular tissue, involving _________________, ______, loss of function, _________, __________________ –Treatment RICE ____________ until soreness has subsided ______________ and ______________ should be avoided initially

17. © 2007 McGraw-Hill Higher Education. All rights reserved. Acute Femoral Fractures –Cause of Injury Generally involving shaft and requiring great force Occurs in ___________ due to _______and ________________ –Signs and Symptoms Shock, pain, swelling, deformity –Must be aware of ______________ and ______________ ___________________ –Treatment Treat for shock, ______________, ____________ _______, reduce following X-ray Secure immediate emergency assistance and medical referral

18. © 2007 McGraw-Hill Higher Education. All rights reserved. Femoral Stress Fractures –Cause of Injury __________ Females who are ___________ are more vulnerable to stress fx –Signs and Symptoms ____________________ X-ray or _________ will reveal fracture Commonly seen in ______________ –Treatment __________________________ ROM and PRE exercises are carried out w/ pain free ROM ______, ________________

19. © 2007 McGraw-Hill Higher Education. All rights reserved. Recognition and Management of Specific Hip, Groin, and Pelvic Injuries Groin Strain –Cause of Injury One of the more difficult problems to diagnose Often seen in ____________ due to __________ and ________________ Occurs from running, jumping, twisting w/ hip ___________ or ____________ –Signs and Symptoms Sudden twinge or tearing during active movement Produce _____, ________, and __________________

20. © 2007 McGraw-Hill Higher Education. All rights reserved. Groin Strain (continued) –Treatment RICE, NSAID’s and analgesics for ___________ Determine _________ or _______________ ______________ Restore normal _____ and ________ -- ________ ________________ Refer to physician if severe groin pain is experienced

21. © 2007 McGraw-Hill Higher Education. All rights reserved. Sprains of the Hip Joint –Cause of Injury Result of ___________ due to ______________ Force from opponent/object or ______________ ____________________________ –Signs and Symptoms Signs of acute injury is the inability to __________ hip Pain in hip region, w/ hip rotation ________________ –Treatment X-rays or MRI should be performed to rule out fx RICE, NSAID’s and analgesics Depending on severity, ___________________ _______ and _____ are delayed until hip is pain free

22. © 2007 McGraw-Hill Higher Education. All rights reserved. Piriformis Syndrome –Cause of Condition Compression of __________; irritation due to ________ or ______ of muscle May mimic ___________ –Signs and Symptoms Pain, __________ and ___________– may extend ________ and __________ Pain may increase following periods of _______, ___________, walking or running –Treatment _____________________ NSAID’s may be prescribed __________________________ will be prescribed Corticosteroid injection may also be suggested Surgery is sometimes an option as well

23. © 2007 McGraw-Hill Higher Education. All rights reserved. Dislocated Hip –Cause of Injury ________________________ Result of traumatic force directed along the long axis of the femur –Signs and Symptoms ___________________________________ Palpation reveals displaced femoral head, _______________ Serious pathology –_____________________________________ –Treatment Immediate medical care (__________________ may be compromised) Prepare for shock 2 weeks immobilization and crutch use for at least one month

24. © 2007 McGraw-Hill Higher Education. All rights reserved. Hip Problems in Adolescent Athletes Legg Calve’-Perthes Disease (Coxa Plana) –Cause of Condition ________________ of the femoral head in child ages 4-10 Articular cartilage becomes ____________________ –Signs and Symptoms Pain in ______that can be referred to the abdomen or knee ___________________ Varying onsets and may exhibit _______________

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26. Legg-Calve’-Perthes Disease –Treatment Bed rest to reduce chance of chronic condition ___________________________ Early treatment and ______________________ _______________ –Complication If not treated early, will result in ill-shaping and ________________ in later life

27. © 2007 McGraw-Hill Higher Education. All rights reserved. Slipped Capital Femoral Epiphysis –Cause of Condition Epiphysis slips from femoral head in _______________ due to weakness in _______________ May occur during periods of elevated growth –Signs and Symptoms Pain in _________ that comes on over weeks or months Hip and knee pain during ________ and ________ motion; limitations of _________, ________, ____________ and a limp –Treatment W/ minor slippage, ________________________________ ____________________ Major displacement requires surgery If undetected or surgery fails severe problems will result

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29. Iliac Crest Contusion (hip pointer) –Cause of Injury Contusion of ________ or _______________ Result of direct blow –Signs of Injury Pain, spasm, and transitory paralysis of soft structures __________________ or _________________ due to pain –Care ______________________________ Bed rest 1-2 days in severe cases Referral must be made, X-ray ____________ should be used upon return to minimize chance of added injury Recognition and Management of Injuries to the Pelvis

30. © 2007 McGraw-Hill Higher Education. All rights reserved.

31. Osteitis Pubis –Cause of Injury Seen in ______________ Repetitive stress on ______________ and _______ ___________ –Signs and Symptoms Chronic pain and inflammation of groin _______________________ Pain w/ __________, ______________ –Treatment Rest, NSAID’s and gradual return to activity

32. © 2007 McGraw-Hill Higher Education. All rights reserved. Acute Fracture of Pelvis –Cause of Injury Result of ________________________ –Signs and Symptoms Severe pain, loss of function, shock –Treatment ______________________ Refer to physician Seriousness of injury dependent on ______________ and ______________________

33. © 2007 McGraw-Hill Higher Education. All rights reserved. Stress Fractures –Cause of injury Repetitive abnormal overused forces –Signs and Symptoms ______________________________________ Discomfort increases with activity and subsides during rest –Treatment Refer to physician for assessment and X-ray Rest for _________________

34. © 2007 McGraw-Hill Higher Education. All rights reserved. Avulsion Fractures –Cause of Injury Avulsions seen in sports w/ sudden accelerations and decelerations Pulling of tendon away and off of bony insertion Common sites include ____________, _________ _________________, ____________________ –Signs and Symptoms Sudden localized pain w/ limited movement Pain, swelling, point tenderness –Treatment ________________________________________

35. © 2007 McGraw-Hill Higher Education. All rights reserved. Assessment of the Thigh History –Mechanism of injury? Observation –____________________ –____________________________ –_____________________

36. © 2007 McGraw-Hill Higher Education. All rights reserved. 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

37. © 2007 McGraw-Hill Higher Education. All rights reserved. Special Tests –______________ Test for hip contractures –______________ Test for hip extensor tightness Can also be used to assess __________ ________________

38. © 2007 McGraw-Hill Higher Education. All rights reserved. Special Tests –________________ ______ Test for weakness in the gluteus medius muscle on the ___________ –_____________ Test for ITB tightness