Anatomy

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Anatomy Injuries to the Thigh, Hip and Pelvis

• Sabino Sports Medicine
• Connie Rauser
• Instructor

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General Information about the pelvis

• This area of body is strong and stable
• Great demand placed on this part of bodycore
• Functions
• support the spine trunk
• Transfer weight to lower extremities
• Place for muscle attachment of thigh and trunk
• Protect organs of pelvic region

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Anatomy

• Bones
• Muscles
• Ligaments

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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

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Bones-the anterior femur
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The posterior femur
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The pelvis
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Muscles

• Hip Flexors
• Iliacus psoas major Iliopsoas
• Rectus femoris
• Sartorius
• Hip Extensors
• Hamstrings-biceps femoris, semitendinosus,
  semimembranosus
• Gluteus maximus

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Muscles

• Knee flexors
• Hamstrings, gastrocnemius
• Knee extensors
• Quadricepsrectus femoris, vastus lateralis,
  vastus medialis, vastus intermedius

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Muscles
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Muscles
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Muscles
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Muscles

• Hip Adductors
• Adductor magnus, adductor longus, adductor
  brevis, gracilis, pectineus
• Hip Abductors
• Gluteus medius, tensor fascia latae

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Muscles
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Muscles
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Muscles

• Hip Internal rotators
• Tensor fascia latae, gluteus minimus
• Hip External rotators
• Gluteus maximus, gluteus medius, piriformis

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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

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Ligaments
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Preventing injuries to thigh/hip

• Flexibility training and stretching
• Strength training
• Proper protective equipment

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Common Injuries

• Strains
• Sprains
• Contusions
• Fractures
• Dislocations

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Strains

• Quads
• Hamstrings
• Groin (adductors)
• Hip flexors
• Gluteals

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Strains

• Mxn
• sudden strong contraction of muscle(s)
• overstretching of muscle(s)
• Muscle strength imbalance

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Strains-hamstring
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Strains- groin
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Strains

• S/S pain/discomfort
• POT
• Bleeding causing discoloration (after 1-2 days)
• Loss of function
• Muscle spasm
• deformity

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Strains

• TX RICE
• modify/restrict activity
• crutches if necessary
• Medical referral if necessary
• Restore normal ROM flexibility and strength using
  various modalities as needed

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Strains

• Complications
• recurrent strains due to inelasticity of scar
  tissue especially at that same site
• Excess buildup of scar tissue

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Strains-quad after the fact
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Strains-quad
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Strains-hamstring
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Strains-hamstring
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Hamstring strain treatment
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Hamstring avulsion
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Contusions

• Quadriceps
• Hip pointer

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Quadriceps Contusion

• Mxn
• direct blow to relaxed thigh compressing the
  musculature again the femur

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Quadriceps Contusion

• S/S
• Pain
• POT
• Bleeding into the muscle
• Swelling
• Temporary loss of function

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Quad contusion

• Tx RICE w/ knee flexed
• Crutches if necessary
• Restore normal ROM, flexibility strength
• Ultrasound
• Heat
• Medical referral if needed

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Quad contusion

• Complication
• Myositis ossificansformation 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

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Myositis Ossificans
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Hip Pointer

• Mxn
• direct blow to the iliac crest and/or ASIS

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• S/S
• Pain
• Spasm
• Bleeding in the areadiscloration
• Temporary loss of motion
• Unable to rotate trunk or flex hip without pain

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Hip Pointer
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Hip Pointer

• Tx
• RICE
• Bed rest if necessary
• Medical referral if necessary
• Return to activity when pain if gone and motion
  is restored

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Fractures-Avulsion

• Most common at ASIS or Ischial Tuberosity
• Mxn forceful contraction of muscle

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Avulsion Fractures

• S/S
• Extreme pain with movement weight bearing
• POT (either over the ASIS or Ischial tub.)
• Bleeding/discoloration

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Avulsion

• TX
• Ice
• crutches
• Medical referral for x-ray

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Fractures- femur

• Occurs most often in the shaft of the femur
• Mxn
• great force-direct or indirect- placed on the
  femur

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Femur Fractures

• S/S
• Pain
• POT
• Deformity w/ thigh externally rotated, shortened
• Loss of motion/function
• Swelling due to internal bleeding
• Muscle spasms
• Muscle lacerations

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Femur fractures

• Can be life threateningfatty tissue and bone
  marrow can get into the blood stream and cause a
  blood clot

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Femur Fracture

• Tx
• Call 911
• Dont move the athlete
• Hare traction splint
• Check for distal pulse
• Control any external bleeding
• Treat for shock

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Femur fractures
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Femur fractures
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Femoral Stress Fracture

• Mxn repetitive stress of the pounding of the
  lower extremity which causes the femur to bend
  (one side is compressed the other is stretched)

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Femoral stress fracture

• S/S
• POT at one specific site
• Pain with activity
• Pain with a compressive force at the site
  (sitting on edge of table)
• Pain with activity

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Femoral Stress fracture

• Tx
• Rest
• Alternate activitynon-weight bearing
• Crutches if limping
• Medical referral---x-rays and bone scan or--

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Femoral stress fx
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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 10-17 yrs.
• Tall and thin
• obese

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Slipped Capital femoral epiphysis

• Mxn
• Not know but may be related to effects of a
  growth hormone
• In ¼ of cases both hips are affected

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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

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Slipped --- epiphysis

• TX
• Minor 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

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Slipped---epiphysis

• Complications
• If displacement goes undetected or if surgery
  fails to restore normal hip mechanics can have
  problems later in life
• Bone doesnt grow properly
• Head of femur doesnt grow properly
• Bone spurs
• Arthritis

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SCFE
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SCFE
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SCFE

• Pins to fix

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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

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LCPD

• Mxn Unknown
• S/S
• complaints of pain in groin, and sometimes
  referred pain to abdomen or knee
• Limited hip movement

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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)

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LCPD
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LCPD

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

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Hip Dislocation

• Rarely occurs in sports
• Most are posterior
• Mxn 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

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Hip Dislocation

• S/S
• Hip in flexion, adduction, and internal rotation
• Deformity posteriorhead of femur can be palpated
  through gluteal muscle
• Extreme pain
• Inability to move at hip joint

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Hip Dislocation
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Hip Dislocation
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Hip Dislocation

• TX
• Call 911
• Dont move athlete
• Splint in position you find them
• Treat for shock

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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)