1. Anatomy & Injuries to the Thigh, Hip and Pelvis

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

6. Bones-the anterior femur

7. The posterior femur

8. The pelvis

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

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

11. Muscles

12. Muscles

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

14. Muscles

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

16. 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

17. Ligaments

18. Hip Movements
Hip Flexion

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 MOI: 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 Pt. tender
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. HAMSTRING WRAP 6” Double ACE wrap
Start around the leg and work your way around the waist.
Pulling the leg into extension.
Athlete is standing with injured leg out in front.
Athlete’s injured leg has a roll of tape underneath the heel, to slightly flex the muscles.

35. Groin Wrap 6” Double ACE wrap
Start around the leg and work your way around the waist.
Pulling the leg into adduction.
Exact same set up as
hamstring wrap.

36. Contusions
Quadriceps
Hip pointer

37. Quadriceps Contusion MOI:
direct blow to relaxed thigh compressing the musculature again the femur

38. Quadriceps Contusion S/S: Pain Pt. tender Bleeding into the muscle
Swelling
Temporary loss of function

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

40. 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

41. Quad Contusion Wrap 6 or 4” Single wrap Contusion Pad/Foam
Athlete has heel on roll of tape.
Place foam or contusion pad over the affected area. Use the elastic wrap starting distal to proximal to cover the foam or pad.

42. Myositis Ossificans

43. Hip Pointer
MOI:
direct blow to the iliac crest and/or ASIS

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

45. Hip Pointer

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

47. Fractures-Avulsion Most common at ASIS or Ischial Tuberosity
MOI: forceful contraction of muscle

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

49. Avulsion
TX:
Ice
crutches
Medical referral for x-ray

50. Fractures- femur Occurs most often in the shaft of the femur MOI:
great force-direct or indirect- placed on the femur

51. Femur Fractures S/S: Pain Pt. tender
Deformity w/ thigh externally rotated, shortened
Loss of motion/function
Swelling due to internal bleeding
Muscle spasms
Muscle lacerations

52. Femur fractures
Can be life threatening—fatty tissue and bone marrow can get into the blood stream and cause a blood clot

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

54. Femur fractures

55. Femur fractures

56. Femoral Stress Fracture
MOI: repetitive stress of the pounding of the lower extremity which causes the femur to bend (one side is compressed the other is stretched)

57. Femoral stress fracture
Pt. tender at one specific site
Pain with activity
Pain with a compressive force at the site (sitting on edge of table)

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

59. Femoral stress fx

60. 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

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

62. 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

63. 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

64. 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

65. SCFE

66. SCFE

67. SCFE
Pins to fix

68. 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

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

70. 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)

71. LCPD

72. LCPD
Complications:
If not treated early enough, the head of femur will be ill (abnormally) shaped producing osteoarthritis in later life

73. Hip Dislocation Rarely occurs in sports Most are posterior
MOI: 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

74. 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

75. Hip Dislocation

76. Hip Dislocation

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

78. 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)

79. Bo Jackson