Chapter 17 The Thigh Hip Groin and Pelvis

© 2007 Mc. Graw-Hill Higher Education. All rights reserved.

Muscles and Movements • Hip flexion – Normal ROM • 120 degrees knee bent

Muscles and Movements (2) • Abduction – Normal ROM • 45 degrees – ________

Muscles and Movements (3) • Internal Rotation or Medial Rotation – Normal ROM •

Assessment of the Thigh • History – Onset (sudden or slow? ) – Previous

• Palpation – Soft tissue of the thigh (anterior, posterior, medial, lateral) should

RROM testing • Hip Flexion • Hip Extension • Hip Abduction • Hip Adduction

• Special Tests – Thomas test • Test for hip contractures_______ – Straight

Special Test Cont • Kendall • Pelvic Rock • Trendelenburg’s Test © 2007 Mc.

Prevention of Thigh Injuries • Thigh must have maximum strength, endurance, and extensibility to

Recognition and Management of Thigh Injuries • Quadriceps Contusions – Cause of Injury •

• Care – RICE and NSAID’s – ______________ ______________ • Heat, massage and

• Myositis Ossificans – Cause of Injury • _________________ – Signs of Injury

• Quadriceps Muscle Strain – Cause of Injury • __________________ • Associated with

• Hamstring Muscle Strains – Cause of Injury • Multiple theories of injury

– Signs of Injury (continued) • Grade 3 - Rupturing of tendinous or muscular

Recognition and Management of Specific Hip, Groin, and Pelvic Injuries • Groin Strain –

• Groin Strain (continued) – Care • _________________ • Determine exact muscle or

• Sprains of the Hip Joint – Cause of Injury • Result of

• Piriformis Syndrome – Cause of Condition • __________________ • _________________ – Signs

Hip Problems in Adolescent Athletes • Legg Calve’-Perthes Disease • Cause of Condition •

• Legg-Calve’-Perthes Disease (continued) • Care – Bed rest to reduce chance of

• Slipped Capital Femoral Epiphysis – Cause of Condition • May be growth

• Iliac Crest Contusion (hip pointer) – Cause of Injury • _________________________________ •

• Avulsion Fractures – Cause of Injury • _________________ • Pulling of tendon

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Muscles and Movements • Hip flexion – Normal ROM • 120 degrees knee bent – Iliacus and psoas major (major flexors)_____________ - knee bent – _________ (function when knee is extended and with kicking the ball) – Sartorius • Hip Extension – Normal ROM 10 – 20 degrees – ________________ © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

Muscles and Movements (2) • Abduction – Normal ROM • 45 degrees – ________ • Adduction – Normal ROM • 30 degrees – Adductor magnus, longus, brevis, and gracilis © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

Muscles and Movements (3) • Internal Rotation or Medial Rotation – Normal ROM • 45 degrees – ________________ • External Rotation or Lateral Rotation – Normal ROM • 45 degrees – 6 deep external rotators- piriformis © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

Assessment of the Thigh • History – Onset (sudden or slow? ) – Previous history? – Mechanism of injury? – Pain description, intensity, quality, duration, type and location? • Observation – Postural symmetry? – Size, deformity, swelling, discoloration? – Skin color and texture? – Is athlete in obvious pain? – Is the athlete willing to move thigh? © 2007 Mc. Graw-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 © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

RROM testing • Hip Flexion • Hip Extension • Hip Abduction • Hip Adduction • Hip Internal Rotation • Hip External Rotation • Knee Extension • Knee flexion © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• Special Tests – Thomas test • Test for hip contractures_______ – Straight Leg Raise • Test for hamstring tightness or • Can also be used to assess sciatic nerve irritation from swelling, bulging/herniated disk or SI joint dysfunction © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

Prevention of Thigh Injuries • Thigh must have maximum strength, endurance, and extensibility to withstand strain • Dynamic stretching programs may aid in muscle preparation for activity • Strengthen programs can also help in preventing injuries – Squats, lunges, leg press – Core strengthening © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

Recognition and Management of Thigh Injuries • Quadriceps Contusions – Cause 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 © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• Care – RICE and NSAID’s – ______________ ______________ • Heat, massage and ultrasound to prevent myositis ossificans – Padding may be worn for additional protection upon return to play © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• Myositis Ossificans – Cause of Injury • _________________ – Signs of Injury • _________________ • Pain, weakness, swelling, decreased ROM • Tissue tension and point tenderness – Care • Treatment must be conservative • May require _________ if too painful and restricts motion • If condition is recurrent it may indicate problem with blood clotting © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• Quadriceps Muscle Strain – Cause of Injury • __________________ • 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; more discoloration; edema will settle in back of knee, calf and ankle – Care – Fit for crutches if necessary • _______________________ • Determine extent of injury early • Neoprene sleeve may provide some added support © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• 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 © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

– 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 • Fit for crutches if necessary © 2007 Mc. Graw-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 early part of season due to poor strength and flexibility • Occurs from running , jumping, twisting w/ hip external rotation or severe stretch – Signs of Injury • Sudden twinge or tearing during active movement • Produce pain, weakness, and internal hemorrhaging © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• Groin Strain (continued) – Care • _________________ • Determine exact muscle or muscles involved • ____________________________ • Refer to physician if severe groin pain is experienced • Fit for Crutches if necessary © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• Sprains of the Hip Joint – Cause of Injury • Result of violent twist due to forceful contact • _________________________________ – Signs of Injury • Signs of acute injury and inability to circumduct hip • Pain in hip region, w/ hip rotation increasing pain – Care • X-rays or MRI should be performed to rule out fx • RICE, NSAID’s and analgesics • Depending on severity, crutches may be required • ROM and PRE are delayed until hip is pain free © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• Piriformis Syndrome – Cause of Condition • __________________ • _________________ – Signs of Injury • Pain, numbness and tingling in butt – may extend below knee and into foot • Pain may increase following periods of sitting, climbing stairs, walking or running – Care • Stretching and massage • NSAID’s may be prescribed • Cessation of aggravating activities will be prescribed • Corticosteroid injection may also be suggested • Surgery is sometimes an option as well © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

Hip Problems in Adolescent Athletes • Legg Calve’-Perthes Disease • Cause of Condition • Avascular necrosis of the femoral head in child ages 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 © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• Legg-Calve’-Perthes Disease (continued) • Care – 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 illshaping and osteoarthritis in later life © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• Slipped Capital Femoral Epiphysis – Cause of Condition • May be growth hormone related • 25% of cases are seen in both hips • ___________________________________ • __________________ – Signs of Condition • Pain in groin that comes on over weeks or months • Hip and knee pain during passive and active motion; limitations of abduction, flexion, medial rotation and a limp – Management • W/ minor slippage, rest and non-weight bearing may prevent further slippage • Major displacement requires surgery • If undetected or surgery fails severe problems will result © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• Iliac Crest Contusion (hip pointer) – Cause of Injury • _________________________________ • ______________ – Signs of Injury • Pain, spasm, and transitory paralysis of soft structures • ____________________ – Care • RICE for at least 48 hours, NSAID’s, • Bed rest 1 -2 days in severe cases • Referral must be made, X-ray • Padding should be used upon return to minimize chance of added injury © 2007 Mc. Graw-Hill Higher Education. All rights reserved.

• Avulsion Fractures – Cause of Injury • _________________ • Pulling of tendon away and off of bony insertion • Common sites include ASIS (____), AIIS (__________), ischial tuberosity (______) – Signs of Injury • Sudden localized pain w/ limited movement • Pain, swelling, point tenderness – Care • Rest, limited activity and graduated exercise © 2007 Mc. Graw-Hill Higher Education. All rights reserved.