Thigh Hip Groin Pelvis Anatomy Injuries Bones Femur

Thigh, Hip, Groin & Pelvis Anatomy & Injuries

Bones: Femur • • • Head Neck Shaft Medial epicondyle Lateral epicondyle

Bones: Pelvis • • • Iliac crest Sacroiliac joint Sacrum Coccyx Acetabulum Pubic symphysis

Bony: Innominate bone • • Illium Iliac Crest Acetabulum Ischium Ishial Tuberosity Pubis Obturator Foramen

Ligaments

Range of Motion • • • Flexion - 120 Abduction - 45 Internal Rotation - 45 Extension – 30 Adduction - 30 External Rotation - 45

Muscle Actions • Flexion: – Iliospoas – Rectus Femoris • Extension: – Gluteus Maximus – Hamstrings • Abductors: – Gluteus Medius – Gluteus Minimus • Adductors: – Adductor Longus/Brevis/Magnus, Pectineus • Internal Rotation: – Adductors • External Rotation: – Piriformis, Obturators, Gemellus, Quadratus Femoris

Muscles:

Prevention • Maintain hip, thigh, pelvis strength/flexibility • Dynamic stretching- quads, hamstrings, groin • Strengthening- squats, lunges, leg press, core strengthening

Injuries • Cause • Signs of Injury • Care

Terms • Etiology– Cause • Pathology– Nature of the injury – Anatomic or functional changes

Quadriceps Contusion Etiology Signs & Symptoms Grades Treatment -Direct blow -Exposed area -Extent of force and degree of thigh relaxation determines depth and functional disruption that occurs - Pain -Temporary loss of function -Loss of ROM -Loss of strength -Immediate effusion/swelling -Palpable swelling -Point tender - Increasing loss of function with higher grades * Potential Myositis Ossificans 1 (mild) None to mild swelling None to mild ↓ROM (knee flexion 0 -90°) None to mild ↓ strength/function 2 (moderate) Moderate intensity Pain, swelling, knee flexion <90°, obvious limp 3 (severe) Major disability Fasciae may split, muscle may portrude/herniate Deep intramuscular hematoma Knee flexion 45 -90° Obvious limp Compression w/ elastic bandage w/ knee flexed PRICE Gentle stretching Crutches if limping Protective pad RTP Quad sets Avoid heat/massage acutely

Myositis Ossificans Etiology Signs & Symptoms Treatment -Severe blow or repeated blows to thigh -Ectopic bone formation in muscle -Attempting to run on quad contusion -Heat or massage on quad contusion too early Following bleeding in quads and formation of blood tumor Disruption of muscle fibers, blood vessels, connective tissue and periosteum of femur = produces cartilage/bone Shows in 2 -4 weeks on x-ray Conservative Surgical removal if no resolution of symptoms in 1 year Early removal may cause return Recurrent MI can indicate problems with clotting

Quadriceps/Hamstring Strains Etiology Signs & Symptoms Grade 1 -Overstretch More centered Mild injury causes more -Strong Fibers are stretched pain -> contraction Some tenderness -Often due to lack Pain with active ROM Grade 2 of strength or Moderate ROM Some torn fibers Active contraction is painful Sulus in muscle belly Possible discoloration Grade 3 Severe Complete rupture of the muscle belly Loss of function Initial pain, then goes away Treatment Rest Ice Pressure Neoprene sleeve/ wrap Re-injury can occur due to healing with inelastic fibrous scar tissue When full ROM and 80% strength return, can RTP https: //youtu. be/A cd. MAf_0 h. W 0

Actute Femoral Fracture (fx) Etiology Signs & Symptoms Treatment -Often in shaft -Fall from a height -Direct blow -Middle third due to curve of bone/exposed to blows Emergency referral Shock Prevent shock ↑ pathology/pain Bone displacement Muscle lacerations Major internal bleeding Muscle spasms Classic signs: Deformity- thigh rotated out Shortened thigh Loss of fxn Pain and pt tend Swelling

Femoral Stress Fx Etiology Signs & Symptoms Treatment -Uncommon at neck, rare at shaft -Endurance athletes -Overuse -Females > males Several weeks after ↑ intensity Pain in groin or anterior thigh that increases w/ activity May persist after Pain may refer to knee Relieved with long rest periods Pain becomes constant Limp Complete rest May completely fx If fx, may be 12 mos

Hip Sprain Etiology Signs & Symptoms Treatment -Violent twist -Foot planted and trunk moves opposite direction -Joint moves out of anatomical norm Inability to circumduct thigh Similar to stress fx Pain in hip Rotation ↑ pain X-ray to r/o fx PRICE Analgesics May restrict WB Crutches ROM and progressive resistance exercises wait until pain free

Hip Dislocation Etiology Signs & Symptoms Treatment Complications -Rare -Traumatic force along axis of femur -Falling on side w/ knee bent Flexed/adducted/ IR thigh Head of femur posterior to acetabulum Capsular tearing Ligamentous damage Often fx Possible sciatic nerve damage/ artery damage = avascular necrosis Medical referral Immobilization 2 weeks bedrest, crutches x 1 month or longer Muscle paralysis Degeneration of femoral head

Hip Labral Tear Etiology Signs & Symptoms Treatment -Repetitive movements (running/pivotin g) = degeneration of joint -Hip dislocation Can be asymptomatic Locking/clicking Pain in hip/groin Stiff/limited ROM Stretch Strengthen Stability exercises Avoid stress to joint Pain meds Corticosteroid injection If pain persists, surgery

Piriformis Syndrome Etiology Signs & Symptoms Treatment -Sciatic nerve compression/ irritation -Common misdiagnosis with sciatica -Sciatica = herniated lumbar disc Pain Numbness Tingling in butt to knee and foot May worsen with sitting, stairs, walking, running Stretching Massage Anti-inflammatories Stop offending activities Corticosteroid injection at site Surgery uncommon

Groin Strain Etiology Signs & Symptoms Grades Treatment -Area between thigh and abdomen -Adduction/IR muscles -Any groin muscle -Running, jumping, twisting w/ ER -Early part of season, esp if poor strength/ ROM -R/o pelvic fx Sudden twinge or feeling of tearing May go unnoticed until post-activity Pain, weakness, internal bleeding Grade 1 Mild Fibers are stretched Some tenderness Pain with active ROM Grade 2 Moderate Some torn fibers Active contraction is painful Sulus in muscle belly Possible discoloration Grade 3 Severe Complete rupture of the muscle belly Loss of function Initial pain, then goes away PRICE When full ROM and 80% strength return, can RTP Groin wrap

Legg-Perthes Disease Etiology Signs & Symptoms Treatment Complications -Coxa plana -Loss of blood flow to head of femur -Children 3 -12 -Boys > girls -Articular cartilage dies and flattens -Avascular necrosis Pain in groin (can refer to abdomen/ knee) Limp Can have rapid onset, usually slow over months Limited ROM w/ pain Bed rest to limit chance of chronic condition Brace If timely tx occurs, may revascularize Osteoarthritis due to misshapen femoral head

Slipped Capital Femoral Epiphysis Etiology Signs & Symptoms Treatment -Adolescents -Epiphysis slips from head -Weakness in growth plate -Periods of accelerated growth -Boys 10 -17, tall and thin -¼ of cases, bilateral Rest and NWB – mild Similar to Legg. Surgery – major Perthes Pain in groin, acute displacement or chronic Prolonged stress or single incident Signs range from minimal to severe hip/knee pain, limited ROM, limp early -> late stages Complications If undetected or failed surgery, hip problems may occur later in life

Hip Pointer Etiology Signs & Symptoms Treatment -Iliac crest contusion -Direct blow Immediate pain Muscle guarding Temporary paralysis of musculature Limited ROM and function Ice Pressure Rest X-ray Protective padding upon RTP

Osteitis Pubis Etiology Signs & Symptoms Treatment -Distance runners -Soccer, football, wrestling -Repetitive stress on pubic symphysis by bones or muscles Groin pain at pubic Rest Anti-inflammatories symphysis Gradual RTP TTP on pubic tubercle Pain with running, sit-ups, squats

Acute Pelvic Fx Etiology Signs & Symptoms Treatment -Rare -Direct trauma Severe pain Severe loss of fxn Shock Tx for shock Referral to physician R/O internal injury

Stress Fx of Pelvis Etiology Signs & Symptoms Treatment -Repetitive oversuse -Intense training or competitive racing Groin pain Aching in thigh Increases with activity Decreases with rest X-ray Physician referral Rest 2 -5 mos

Avulsion Fx Etiology Signs & Symptoms Treatment -Forceful muscle contraction -Sartorius to ASIS -RF to AIIS -Hamstrings to ischial tuberosity Sudden localized pain Limited ROM Swelling Point tenderness X-ray Physician referral Rest Limited activity Gradual RTP