HIP AND THIGHCommon Injuries

STRAINS Quad, Hip Flexor, and

groin strains commonly occur from explosive movement

c/o “popping” or “pulling” feeling. Typically athlete can not continue activity. Strains that RTP too soon,

or are left untreated with RTP can result in avulsion fx

Signs and Symptoms Pain, swelling, decreased ROM secondary to pain

Treatment Rest, ice, ROM activities, electrical stimulation

for tissue regeneration, Progressive Resistive Strength Training

CONTUSIONS

Quadriceps Contusion - Results from a traumatic or repetitive impact to a

relaxed quad muscle, compressing the muscle against the femur

Quadriceps Contusion Cont’d Signs and Symptoms –

Pain, temporary loss of function, capillary bleeding, swelling, pain to the touch

Treatment – Immediately placed in flexion to stretch the

muscle (to prevent shortening), with ice pack to minimize swelling/bleeding and moderate pain. RICE and NSAIDs prescribed as needed

ROM (mild stretching), WBAT, and PRE within pain free ROM Heat, aggressive massage, and ultrasound are all

contraindicated

Hip Pointer – Occurs from a

blow to an inadequately protected hip (iliac crest and abdominal musculature)

Considered one of the most debilitating and hard to manage injuries in contact sports.

Hip pointer cont’d Signs and Symptoms –

Immediate pain, spasms, temporary paralysis of muscles. As a result, Ath is unable to rotate trunk, or flex the thigh without pain.

Treatment – RICE Ice cup massage Initially, steroid injection to manage pain,

followed by oral NSAIDs Recovery 1 to 3 wks

MOI is same as Iliac crest fx, Ath must be seen for Xray to RO

MYOSITIS OSSIFICANS

Occurs from a severe blow or repeated blows to quadriceps muscle. Failure to control initial

bleeding from quad contusion, or tx that it too aggressive can produce calcification in the muscle.

Signs and Symptoms – Pain, weakness, soreness,

swelling, decreased ROM Treatment –

Sx excision 1 yr post injury.

FEMORAL FRACTURE

Acute – Occurs in middle aged athletes, and elderly

patients. Osteoporosis is a pre-disposing condition High incident of Avascular Necrosis in adolescent

patients due to skeletal immaturity and inadequate blood supply

Fx w/o obvious deformity: c/o pain, no ROM, inability to WB. Ath is muscle-gaurding and resists any attempts to be moved. Hip is often EXTERNALLY rotated and slight adducted. Shortening of the limb is sometimes evident.

FEMORAL FX

http://www.youtube.com/watch?v=rO_nSjF_Jl0

FEM FX CONT’D

FEM FX CON’T

Treatment – Immobilized and transported for immediate

medical care. Physician will either do a close reduction, or open reduction, depending on placement of fracture and number of fracture sites. ORIF (open Reduction Internal Fixation) requires pins

and rods Following surgery, ath will be immobilized in

hinge brace and will require PT. Rehabilitation typically takes 4 months

FEM FX CON’T

Stress fracture Fairly uncommon, occurring most often in

endurance athletes, and are more common in FEMALE athletes (MOI Overuse)

Signs and symptoms – Pain in groin or anterior thigh, pain increasing

during activity; pain may be referred to knee. Positive Trendelenburg’s sign. Early x rays may not show fracture.

Treatment – Complete rest with calcium and Vitamin D

supplementation. Untreated stress fx can result in displaced femoral fx, then requiring sx

LEG LENGTH DISCREPANCY

Simply put: one leg is shorter than the other In non-active individuals,

a LLD of 1” will produce symptoms. In highly-active individuals, an LLD of 1/8” will produce symptoms.

3 types: True (Anatomical) Apparent Functional

LLD CONT’D

True: Either Femur or Tibia is shorter when compared bilaterally. In some cases BOTH Femur and Tibia are shorter. To Measure: Ath is supine, measurements taken

from medial malleoli to ASIS

Apparent: Not a true LLD. Bone length is the same when measured. Apparent shortening is caused by pelvic rotation. Can be fixed/treated.

Functional: Deformity in bone causes LLD, such as Genu Valgum/Genu Varum (bow-legged, Pigeon-toed). Can not be fixed. Measurements taken from medial malleoli to umbilicus

Left: Genu Valgum (Knock-kneed)Bottom: Genu Varum (bow-legged)

TROCHANTERIC BURSITISInflammation of the bursae caused by friction from the muscle or tendons surrounding the area.

Signs and Symptoms: c/o P in lateral hip which may radiate down to knee. TTP over greater trochanter. AT must r/o ITB tightness

Treatment: RICE, NSAIDS, ROM, and PRE. Avoid running on inclined surfaces. LLD and female athletes w/ increased Q-angle are more at risk

HIP DISLOCATION

https://www.youtube.com/watch?v=vXLLdU8-jO8

MOI: Traumatic force along axis of femur when knee is flexed. Can displace anteriorly or posteriorly. Posterior

dislocation are more common. Posterior dislocations cause femoral shaft to

adduct and flex

HIP DISLOC CONT’D

Signs and Symptoms: Presents with a flexed, adducted, and internally

rotated femur, extreme pain and no ROM available

Treatment: Immediately reduce by medical professional.

Immobilize and rest for 2 weeks. Use of crutches for ambulation approx 4 weeks

Complications: Serious tearing to capsular ligaments, fracture to

femur (head or neck) Sciatic Nerve damage, later development of osteoarthritis, avascular necrosis of femoral head due to interrupted blood supply

HIP REDUCTION

http://www.youtube.com/watch?v=sGQZaqB48rw

HIP DISLOCATION OVERVIEW

https://www.youtube.com/watch?v=mAL-Szu7qAc

HIP LABRAL TEAR

MOI: Commonly from overuse – running and cutting;

can occur acutely from hip dislocation

HIP LABRAL TEAR CONT’D

Signs and Symptoms Most often asymptomatic. Occasionally: catching,

locking, or clicking, pain in the hip or groin, and feeling stiff or having decreased ROM

Treatment: Hips strengthening and proprioception, avoiding

movements that cause pain, NSAIDs, injections of corticosteriod. If pain persists longer than 4 weeks, sx considered to removed or repair

LEGG-CALVE-PERTHES DISEASE

Avascular necrosis of the femoral head Occurs in boys more than girls Occurs in ages 4 to 10

Etiology not always understood. Trauma only accounts for 25% on cases (femoral fx/hip dislocation)

Signs and Symptoms: Pain in groin, abdomen or knees. Limping is

common. Evaluations will only show limited ROM and pain. MRI/Xray needed

LEG

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LEGG-CALVE-PERTHES DISEASE CONT’D

Treatment: Complete bed rest. If treated in time, femoral

head could re-vascularize and re-ossify

Complications: Head of the femur will become ill-shaped and

cause osteoarthritis in the future

SLIPPED CAPITAL FEMORAL EPIPHYSIS

MOI: idiopathic potentially related to a growth hormone Mostly seen in boys, ages 10-17 Tall and thin, or obese Trauma only account for 25% of cases (femoral

fx/hip dislocation)

Signs and Symptoms: Similar to those of LCP

Treatment: Minor slippage: rest and NWB may prevent further

slippage Major displacement: corrective surgery required

LAST ONE!

SNAPPING HIP SYNDROME

ITB moving over the greater trochanter of the femur Excessive repetitive movements found in

athletes such as dancers, gymnasts, hurdlers, and sprinters – creates a muscle imbalance

Signs and Symptoms: Pain, with a visible “clunk” while patient re-

enacts motion

Treatment: Decrease inflammation and pain with ice,

NSAIDs, stretching and strengtheing

SNAPPING HIP SYNDROME

https://www.youtube.com/watch?v=SUXOqfT2zC4