Anatomy & Injuries to the Anatomy & Injuries to the Thigh, Hip and PelvisThigh, Hip and Pelvis
SP Sports MedicineSP Sports MedicineJohn HardinJohn HardinInstructorInstructor
General Information about the General Information about the pelvispelvis
This area of body is strong and stableThis area of body is strong and stable Great demand placed on this part of bodyGreat demand placed on this part of body
—”core”—”core” Functions: Functions:
support the spine & trunksupport the spine & trunk Transfer weight to lower extremitiesTransfer weight to lower extremities Place for muscle attachment of thigh and trunkPlace for muscle attachment of thigh and trunk Protect organs of pelvic regionProtect organs of pelvic region
AnatomyAnatomy
BonesBones MusclesMuscles Ligaments Ligaments
BonesBones
FemurFemur Head, neck, greater trochanter, lesser Head, neck, greater trochanter, lesser
trochanter, shaft, medial & lateral condyle trochanter, shaft, medial & lateral condyle and epicondylesand epicondyles
PelvisPelvis Ilium: iliac crest, ASIS, AIIS, PSISIlium: iliac crest, ASIS, AIIS, PSIS Ishcium: ischial tuberosityIshcium: ischial tuberosity Pubis: Pubic symphysisPubis: Pubic symphysis AcetabulumAcetabulum
Bones-the anterior femurBones-the anterior femur
The posterior femurThe posterior femur
The pelvisThe pelvis
MusclesMuscles
Hip Flexors:Hip Flexors: Iliacus & psoas major= IliopsoasIliacus & psoas major= Iliopsoas Rectus femorisRectus femoris SartoriusSartorius
Hip Extensors:Hip Extensors: Hamstrings-biceps femoris, Hamstrings-biceps femoris,
semitendinosus, semimembranosussemitendinosus, semimembranosus Gluteus maximusGluteus maximus
MusclesMuscles
Knee flexors:Knee flexors: Hamstrings, gastrocnemiusHamstrings, gastrocnemius
Knee extensors:Knee extensors: Quadriceps—rectus femoris, vastus Quadriceps—rectus femoris, vastus
lateralis, vastus medialis, vastus lateralis, vastus medialis, vastus intermediusintermedius
MusclesMuscles
MusclesMuscles
MusclesMuscles
MusclesMuscles
Hip Adductors:Hip Adductors: Adductor magnus, adductor longus, Adductor magnus, adductor longus,
adductor brevis, gracilis, pectineusadductor brevis, gracilis, pectineus Hip Abductors:Hip Abductors:
Gluteus medius, tensor fascia lataeGluteus medius, tensor fascia latae
MusclesMuscles
MusclesMuscles
MusclesMuscles
Hip Internal rotators:Hip Internal rotators: Tensor fascia latae, gluteus minimusTensor fascia latae, gluteus minimus
Hip External rotators:Hip External rotators: Gluteus maximus, gluteus medius, Gluteus maximus, gluteus medius,
piriformispiriformis
LigamentsLigaments Thickening of joint capsule allows for Thickening of joint capsule allows for
very stable jointvery stable joint IliofemoralIliofemoral IschiofemoralIschiofemoral pubofemoralpubofemoral
Ligamentum TeresLigamentum Teres Also called the round ligamentAlso called the round ligament Attaches head of femur into acetabulum Attaches head of femur into acetabulum
allowing blood supply to that areaallowing blood supply to that area
LigamentsLigaments
Preventing injuries to Preventing injuries to thigh/hipthigh/hip
Flexibility training and stretchingFlexibility training and stretching Strength trainingStrength training Proper protective equipmentProper protective equipment
Common InjuriesCommon Injuries
StrainsStrains SprainsSprains ContusionsContusions Fractures Fractures DislocationsDislocations
StrainsStrains
QuadsQuads HamstringsHamstrings Groin (adductors)Groin (adductors) Hip flexorsHip flexors GlutealsGluteals
StrainsStrains
Mxn: Mxn: sudden strong contraction of muscle(s) sudden strong contraction of muscle(s) overstretching of muscle(s)overstretching of muscle(s) Muscle strength imbalanceMuscle strength imbalance
Strains-hamstringStrains-hamstring
Strains- groinStrains- groin
StrainsStrains
S/S: pain/discomfortS/S: pain/discomfort POTPOT Bleeding causing discoloration (after Bleeding causing discoloration (after
1-2 days)1-2 days) Loss of functionLoss of function Muscle spasmMuscle spasm deformitydeformity
StrainsStrains
TX: RICETX: RICE modify/restrict activitymodify/restrict activity crutches if necessarycrutches if necessary Medical referral if necessaryMedical referral if necessary Restore normal ROM flexibility and Restore normal ROM flexibility and
strength using various modalities as strength using various modalities as neededneeded
StrainsStrains
Complications:Complications: recurrent strains due to “inelasticity recurrent strains due to “inelasticity
of scar tissue” especially at that of scar tissue” especially at that same sitesame site
Excess buildup of scar tissueExcess buildup of scar tissue
Strains-quad after the factStrains-quad after the fact
Strains-quadStrains-quad
Strains-hamstringStrains-hamstring
Strains-hamstringStrains-hamstring
Hamstring strain treatmentHamstring strain treatment
Hamstring avulsionHamstring avulsion
ContusionsContusions
QuadricepsQuadriceps Hip pointerHip pointer
Quadriceps ContusionQuadriceps Contusion
Mxn: Mxn: direct blow to relaxed thigh compressing direct blow to relaxed thigh compressing
the musculature again the femurthe musculature again the femur
Quadriceps ContusionQuadriceps Contusion
S/S: S/S: PainPain POTPOT Bleeding into the muscleBleeding into the muscle SwellingSwelling Temporary loss of functionTemporary loss of function
Quad contusionQuad contusion Tx: RICE w/ knee flexedTx: RICE w/ knee flexed Crutches if necessaryCrutches if necessary Restore normal ROM, flexibility & Restore normal ROM, flexibility &
strengthstrength UltrasoundUltrasound HeatHeat Medical referral if neededMedical referral if needed
Quad contusionQuad contusion
Complication:Complication: Myositis ossificans—formation of bony Myositis ossificans—formation of bony
tissue within the muscletissue within the muscle Very painfulVery painful Greatly restricts ROM mainly flexionGreatly restricts ROM mainly flexion
Caused by: Caused by: severe blow that is not properly cares forsevere blow that is not properly cares for Repeated blows to same areaRepeated blows to same area
Myositis OssificansMyositis Ossificans
Hip PointerHip Pointer
Mxn: Mxn: direct blow to the iliac crest and/or ASISdirect blow to the iliac crest and/or ASIS
S/S: S/S: PainPain SpasmSpasm Bleeding in the area—disclorationBleeding in the area—discloration Temporary loss of motionTemporary loss of motion
Unable to rotate trunk or flex hip without Unable to rotate trunk or flex hip without painpain
Hip PointerHip Pointer
Hip PointerHip Pointer
Tx: Tx: RICERICE Bed rest if necessaryBed rest if necessary Medical referral if necessaryMedical referral if necessary Return to activity when pain if gone and Return to activity when pain if gone and
motion is restoredmotion is restored
Fractures-AvulsionFractures-Avulsion
Most common at ASIS or Ischial Most common at ASIS or Ischial TuberosityTuberosity
Mxn: forceful contraction of muscleMxn: forceful contraction of muscle
Avulsion FracturesAvulsion Fractures
S/S: S/S: Extreme pain with movement & Extreme pain with movement &
weight bearingweight bearing POT (either over the ASIS or Ischial POT (either over the ASIS or Ischial
tub.)tub.) Bleeding/discolorationBleeding/discoloration
AvulsionAvulsion
TX: TX: Ice Ice crutchescrutches Medical referral for x-rayMedical referral for x-ray
Fractures- femurFractures- femur
Occurs most often in the shaft of the Occurs most often in the shaft of the femurfemur
Mxn: Mxn: great force-direct or indirect- placed on great force-direct or indirect- placed on
the femurthe femur
Femur FracturesFemur Fractures
S/S:S/S: PainPain POTPOT Deformity w/ thigh externally rotated, Deformity w/ thigh externally rotated,
shortenedshortened Loss of motion/functionLoss of motion/function Swelling due to internal bleedingSwelling due to internal bleeding Muscle spasmsMuscle spasms Muscle lacerationsMuscle lacerations
Femur fracturesFemur fractures
Can be life threatening—fatty tissue Can be life threatening—fatty tissue and bone marrow can get into the and bone marrow can get into the blood stream and cause a blood clotblood stream and cause a blood clot
Femur FractureFemur Fracture
Tx: Tx: Call 911Call 911 Don’t move the athleteDon’t move the athlete Hare traction splintHare traction splint Check for distal pulseCheck for distal pulse Control any external bleedingControl any external bleeding Treat for shockTreat for shock
Femur fracturesFemur fractures
Femur fracturesFemur fractures
Femoral Stress FractureFemoral Stress Fracture
Mxn: repetitive stress of the Mxn: repetitive stress of the pounding of the lower extremity pounding of the lower extremity which causes the femur to bend (one which causes the femur to bend (one side is compressed the other is side is compressed the other is stretched)stretched)
Femoral stress fractureFemoral stress fracture
S/S:S/S: POT at one specific sitePOT at one specific site Pain with activityPain with activity Pain with a compressive force at the site Pain with a compressive force at the site
(sitting on edge of table)(sitting on edge of table) Pain with activityPain with activity
Femoral Stress fractureFemoral Stress fracture
Tx: Tx: RestRest Alternate activity—non-weight bearingAlternate activity—non-weight bearing Crutches if limpingCrutches if limping Medical referral---x-rays and bone scan Medical referral---x-rays and bone scan
or--or--
Femoral stress fxFemoral stress fx
Slipped Capital Femoral Slipped Capital Femoral EpiphysisEpiphysis
Growth plate injury (epiphyseal Growth plate injury (epiphyseal fracture)fracture)
Occurs at the capital femoral Occurs at the capital femoral epiphysis (where neck joins the head epiphysis (where neck joins the head of femur)of femur)
More common in boys 10-17 yrs.More common in boys 10-17 yrs. Tall and thin Tall and thin obeseobese
Slipped Capital femoral Slipped Capital femoral epiphysisepiphysis
Mxn: Mxn: Not know but may be related to effects Not know but may be related to effects
of a growth hormoneof a growth hormone In ¼ of cases both hips are affectedIn ¼ of cases both hips are affected
Slipped---epiphysisSlipped---epiphysis S/S:S/S:
Pain in groin area that Pain in groin area that arises suddenly as a result of traumaarises suddenly as a result of trauma arises slowly over weeks or months as a arises slowly over weeks or months as a
result of prolonged stressresult of prolonged stress Early signs minimal but later get pain in Early signs minimal but later get pain in
hip and kneehip and knee Major limitations with movementMajor limitations with movement Limp when walkingLimp when walking
Slipped --- epiphysisSlipped --- epiphysis TX: TX: Minor casesMinor cases
RestRest Non-weight bearing to prevent further Non-weight bearing to prevent further
slippageslippage Medical referralMedical referral
Major casesMajor cases Surgery to repair “fracture” usually put Surgery to repair “fracture” usually put
pins into bone to keep in place and allow pins into bone to keep in place and allow for proper healingfor proper healing
Slipped---epiphysisSlipped---epiphysis Complications: Complications: If displacement goes undetected or if If displacement goes undetected or if
surgery fails to restore normal hip surgery fails to restore normal hip mechanics can have problems later in mechanics can have problems later in lifelife Bone doesn’t grow properlyBone doesn’t grow properly Head of femur doesn’t grow properlyHead of femur doesn’t grow properly Bone spursBone spurs ArthritisArthritis
SCFESCFE
SCFESCFE
SCFESCFE Pins to fixPins to fix
Legg-Calve-Perthes DiseaseLegg-Calve-Perthes Disease Disruption of blood flow to the head Disruption of blood flow to the head
of femur causing the bone tissue to of femur causing the bone tissue to die and become flatteneddie and become flattened
Occurs in children 3-12 yrsOccurs in children 3-12 yrs Occurs in boys 4 times more often Occurs in boys 4 times more often
than girlsthan girls Usually occurs in first bornUsually occurs in first born Affect usually only one hipAffect usually only one hip
LCPDLCPD
Mxn: UnknownMxn: Unknown
S/S: S/S: complaints of pain in groin, and complaints of pain in groin, and
sometimes referred pain to abdomen or sometimes referred pain to abdomen or kneeknee
Limited hip movementLimited hip movement
LCPDLCPD Tx: Tx: Medical referralMedical referral Bed rest or non-weight bearingBed rest or non-weight bearing If treated in time, the head of femur If treated in time, the head of femur
will revascularize and regain its will revascularize and regain its normal shape (the old cells that die normal shape (the old cells that die will be resorbed and new bone cells will be resorbed and new bone cells laid down to take their place) laid down to take their place)
LCPDLCPD
LCPDLCPD
Complications:Complications: If not treated early enough, the head of If not treated early enough, the head of
femur will be ill (abnormally) shaped femur will be ill (abnormally) shaped producing osteoarthritis in later lifeproducing osteoarthritis in later life
Hip DislocationHip Dislocation Rarely occurs in sportsRarely occurs in sports Most are posteriorMost are posterior
Mxn: traumatic force along the long Mxn: traumatic force along the long axis of the femur such as falling on axis of the femur such as falling on one side with the knee bent (and one side with the knee bent (and landing on that bent knee) forcing landing on that bent knee) forcing head of femur posteriorlyhead of femur posteriorly
Hip DislocationHip Dislocation
S/S: S/S: Hip in flexion, adduction, and internal Hip in flexion, adduction, and internal
rotationrotation Deformity posterior—head of femur can Deformity posterior—head of femur can
be palpated through gluteal musclebe palpated through gluteal muscle Extreme painExtreme pain Inability to move at hip jointInability to move at hip joint
HipHip DislocationDislocation
Hip DislocationHip Dislocation
Hip DislocationHip Dislocation
TX: TX: Call 911 Call 911 Don’t move athleteDon’t move athlete Splint in position you find themSplint in position you find them Treat for shockTreat for shock
Hip DislocationHip Dislocation
Complications:Complications: Tears in the vascular and nerve Tears in the vascular and nerve
structuresstructures Blood vessels to ligamentum teres may Blood vessels to ligamentum teres may
be torn (as will the ligament itself)be torn (as will the ligament itself) Sciatic nerve may be damagedSciatic nerve may be damaged
Paralysis of muscles in the areaParalysis of muscles in the area Atrophic necrosis (degeneration of Atrophic necrosis (degeneration of
femoral head)femoral head)