Knee Injuries by liaoqinmei


									Chapter 13
Hip, Pelvis, and Thigh Injuries
    The Hip, Pelvis, and Thigh

   Includes some of the
    strongest muscles in the
   Subjected to
    tremendous demands.
   Extremely vulnerable to
    injuries that can sideline
    a player for an
    extensive period of
Anatomy of the Hip and Pelvis

   The hip joint is a ball-and-socket joint that allows
    motion and provides stability needed to bear
    body weight
   The socket area, which is inside the pelvis, is
    called the acetabulum. The ball part of this joint
    is the top of the leg bone (head). It joins with the
    acetabulum to form the hip joint.
Anatomy of the Thigh
                    Bones
                        The femur
                     •   Designed to permit maximum
                         mobility and support during
                     •   Longest and strongest bone in
                         the body
                     •   Extends from the hip to the
                     •   The head of femur articulates
                         with the pelvis to form the hip
Anatomy of the Thigh
                   Pelvis
                     Ilium

                     Ischium

                     Pubis
Muscles of the Hip
                        Most powerful in
                         the body
                        Hip Flexors
                          Rectus femoris
                          Sartorius

                          Iliopsoas
                                Psoas major
                                Psoas minor
                                iliacus
     Muscles of the Hip

   Hip Extensors
     Hamstrings
       Biceps femoris
       Vastus lateralis
       Vastus medialis

     Gluteus    maximus
Muscles of the Hip
                        Abductors
                          Gluteus
                          Gluteus
                          Tensor fascia
Muscles of the Hip/Thigh
                     Medial Thigh Muscles
                     Primary function:
                       Gracilis
                       Adductor magnus

                       Adductor brevis

                       Adductor longus

                       Pectineus
Thigh Injuries
                    Very few sprained
                     ligaments or
                     dislocations in this area
                    Proper flexibility and
                     strength prevents most
                     hip injuries
                    Proper equipment also
Thigh Injuries

   Quadriceps Contusion
     Symptoms   & Signs
       Caused   by sharp blow to thigh
       Severe impact from relaxed thigh (muscle to femur)
       Extent of force and degree of thigh relaxation determines
        depth of injury
       Feels like a muscle bruise
       Produces intense pain and weakness
       Grades 1 - 4 depending on severity of injury
Thigh Injuries
  Management
    RICE
    Use elastic bandage for pressure and support in the
     quadriceps area
    Constant stretching of quadriceps muscle
    Do not exercise if pain is still occurring
    Begin slowly with swimming, jogging, etc...
Thigh Injuries

   Myositis Ossificans (bone growth in muscle)
     Symptoms   & Signs
       Pain, muscle weakness, soreness, swelling, decreased muscle
        function, ROM
       Caused by multiple blows to the muscle area
       A single severe blow
       Improper care of a contusion

     Management
       PRICE
       Do not ignore quadriceps contusions
       Remove surgically after one year
Thigh Injuries

   Quadriceps & Hamstring Strains
       Symptoms & Signs
           Pain, discomfort, point tenderness, spasms, soreness
           Grade 1 = mostly spasms, grade 3 = rupture of tendon/muscle
           Strains tend to reoccur because of scar tissue that forms during the
            healing process
       Management
           PRICE, NSAIDS, analgesics
           Cryotherapy
           Preventative – stretch, warm up, use proper form
Thigh Injuries

   Stress Fractures and Femur Fractures
       Symptoms & Signs
           Stress fracture – femur bends slightly, pain and discomfort from
            pounding of lower extremity (running)
           Femur Fracture – severe pain, loss of function, internal bleeding,
       Management for stress fracture:
           Rest
           An alternative activity
    -Management for femur fracture:
           Immobilization, once at hospital traction splint may be used to pull
            femur and reduce pain
Femur Fractures
Anatomy of the Hip and Pelvis
                      Bones
                          Ilium
                              Broad, flaring portion of
                               hip bone
                              Crest of the pelvis
                          Pubis
                              Lower, posterior part of hip
                          Ischium
                              Helps to form the hip
Hip injuries
   Hip Pointer
     Injuryto the iliac crest
     Can be as minimal as contusion or as major as an
      avulsion fracture
     Can be very painful and debilitating
Hip Injuries/Conditions

   Legg-Calve-Perthes Disease
    A   disruption of blood flow to the head of the femur
     The 'ball' of the 'ball and socket' joint dies

     Usually is seen in children 2 to12 years of age, five
      times more common in boys than girls
     Characterized by extreme pain in groin and knee
      area, or walking with limp
Hip Injuries

   Dislocation of hip – Femur pops out of the socket
       Causes
           Athletic injuries
           Car accidents
           Severe falls
       Signs & Symptoms
           Extreme pain
           Leg is often internally rotated
           Possible loss of feeling in foot or leg due to nerve damage
           X-Ray or position of leg usually determines this injury
Hip Injuries - Dislocation
  Management
    Callambulance immediately, hospital will relocate hip
    Months of rehab needed – very long process
    Begin with normal ROM and strength
    May need to learn how to walk again
Hip injuries - Snapping Hip
   The snapping hip – The IT band snaps over the greater
    trochanter hip stability becomes lessened and ligaments and
    adductor muscles become less stable.
    - Causes
           Habitual movements that predispose muscles around the hip to become
           Greater range of motion of hip abduction
           Dancers, gymnasts, hurdlers – structurally narrow pelvic width
       Signs & Symptoms
           Snapping occurs when balancing on one leg
           Pain and inflammation with the snapping
Hip snapping
Hip injuries – Hip snapping
  Management
    Cryotherapy
    Ultrasound  to stretch tight muscles and strengthen weak
     muscles in the hip region
    Resume activity when the pain subsides
Slipped Capital Femoral Epiphysis

   The head of the femur slips off of the neck or shifts
     Found mostly in boys between 10 -17 who are tall & thin or
     May be related to the effects of a growth hormone

     Signs & Symptoms
           Pain in the groin, limping
           Hip and knee pain during passive and active motion
Avascular Necrosis

   Temporary or permanent loss of the blood supply
    to the proximal femur.
    - Causes
         Without blood, the bone tissue dies and causes a collapse of the
          joint surface.
         Use of steroids can cause AVN
    - Signs and Symptoms
         No symptoms in the early stages
         Joint pain, at first during activity, then during rest
         Osteoarthritis may develop after a period of time
Avascular Necrosis
  Management
    See  physician for an MRI, X-ray, or CT scan
    Electrical stimulation, ROM exercises, reduce weight bearing
    Surgery will eventually be required to repair the joint
Groin Strains and Avulsions
    Groin Strains

   Groin strains usually involve the adductor group
    (especially adductor longus)
       Causes
         Running, jumping, or twisting with external rotation
         Sports that require stretching of the hip
         Rapid changes in speed or direction (soccer)
       Signs & Symptoms
         Complete rupture of the muscles that attach the pelvis bone to the
           femur bone.
         Pain, weakness, and internal hemorrhage
         A sudden twinge or feeling of tearing
Groin Strains

  Management
    RICE, NSAIDs, anagelsics for 48 – 72 hours after injury
    Rest
    Daily whirlpool therapy or cryotherapy
    Ultrasound
    Gradual stretching to restore ROM
    Protective spica bandages can be worn or Sawa groin &
     thigh braces
Hip, Thigh, and Groin Stretches
Hip, Thigh, and Groin Stretches

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