Chapter_2017 by mrsmirf


									Thigh, Hip, Groin,
    & Pelvis
Arnheim and Prentice Chapter 17
Anatomy of the Pelvis, Thigh,
and Hip
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 the thigh?
   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
   Special Tests
       Thomas test
            Test for hip

       Straight Leg Raise
            Test for hip
             extensor tightness   Thomas Test
            Can also be used
             to assess low
             back or SI joint
Prevention of Thigh Injuries
   Thigh must have maximum strength,
    endurance, and extensibility to withstand
   Dynamic stretching programs may aid in
    muscle preparation for activity
   Strengthen programs can also help in
    preventing injuries
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
   Care
       RICE and NSAID’s
       Crutches for more
        severe cases
       Isometric quadriceps
        contractions should
        begin as soon as
       Heat, massage and
        ultrasound to prevent
        myositis ossificans
       Padding may be worn
        for additional
        protection upon return
        to play
   Myositis Ossificans Traumatica
       Cause of Injury
            Formation of ectopic bone following repeated
             blunt trauma
       Signs of Injury
            X-ray shows calcium deposit 2-6 weeks
             following injury
            Pain, weakness, swelling, decreased ROM
            Tissue tension and point tenderness
       Care
            Treatment must be conservative
            May require surgical removal if too painful and
             restricts motion (after one year - remove too
             early and it may come back)
            If condition is recurrent it may indicate problem
             with blood clotting
   Quadriceps Muscle Strain
       Cause of Injury
          Sudden stretch when athlete falls on bent knee or
           experiences sudden contraction
          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
          Complete tear may leave athlete w/ little disability and
           discomfort but with some deformity
       Care
          Rest, ice and compression to control internal bleeding

          Determine extent of injury early

          Neoprene sleeve may provide some added support
   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
            Grade 2 - partial tear, identified by sharp snap
             or tear, severe pain, and loss of function
   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
   Acute Femoral Fractures
       Cause of Injury
          Generally involving shaft and requiring great force

          Occurs in middle third due to structure and point of

       Signs of Injury
          Shock, pain, swelling, deformity

              Must be aware of bone displacement and gross
          Loss of function

       Care
          Treat for shock, verify neurovascular status, splint before

           moving, reduce following X-ray
          Secure immediate emergency assistance and medical

   Femoral Stress Fractures
       Cause of Injury
            Overuse
            Females who are amenorrheic are more
             vulnerable to stress fx
       Signs of Injury
            Persistent pain in thigh
            X-ray or bone scan will reveal fracture
            Commonly seen in femoral neck
       Management
            Analgesics, NSAID’s RICE
            ROM and PRE exercises are carried out w/
             pain free ROM
            Rest, limited weight bearing
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
   Groin Strain (continued)
       Care
           RICE, NSAID’s and analgesics for 48-72 hours
           Determine exact muscle or muscles involved
           Rest is critical
           Restore normal ROM and strength -- provide
            support w/ wrap
           Refer to physician if severe groin pain is
   Sprains of the Hip Joint
       Cause of Injury
          Result of violent twist due to forceful contact

          Force from opponent/object or trunk forced over planted
           foot in opposite direction
       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
   Dislocated Hip
       Cause of Injury
          Rarely occurs in sport

          Result of traumatic force directed along the long axis of the
       Signs of Injury
          Flexed, adducted and internally rotated hip

          Palpation reveals displaced femoral head, posteriorly

          Serious pathology

              Soft tissue, neurological damage and possible fx
       Care
          Immediate medical care (blood and nerve supply may be
          Contractures may further complicate reduction

          2 weeks immobilization and crutch use for at least one month
    Hip Problems in the Young Athlete
   Legg-Perthes Disease (Coxa Plana)
       Cause of Condition
          Avascular necrosis of the femoral head in child age 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
•Legg-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
   Complication
       If not treated early, will result in ill-shaping and
        osteoarthritis in later life
   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
   Iliac Crest Contusion (hip pointer)
       Cause of Injury
            Contusion of iliac crest or abdominal
            Result of direct blow
       Signs of Injury
            Pain, spasm, and transitory paralysis of soft
            Decreased rotation of trunk or thigh/hip flexion
             due to pain
       Care
            RICE for at least 48 hours, NSAID’s,
            Bed rest 1-2 days in severe cases
            Referral must be made, X-ray
   Osteitis Pubis
       Cause of Injury
            Seen in distance runners
            Repetitive stress on pubic symphysis and
             adjacent muscles
       Signs of Injury
            Chronic pain and inflammation of groin
            Point tenderness on pubic tubercle
            Pain w/ running, sit-ups and squats
       Management
            Rest, NSAID’s and gradual return to activity
   Acute Fracture of Pelvis
       Cause of Injury
            Result of direct blow or blunt trauma
       Signs of Injury
            Severe pain, loss of function, shock
       Care
            Immediately treat for shock
            Refer to physician
            Seriousness of injury dependent on extent of
             shock and possibility of internal injury
   Stress Fractures
       Cause of injury
            Repetitive abnormal overused forces
       Signs of Injury
            Groin pain, w/ aching sensation in thigh that
             increases w/ activity and decreases w/ rest
            Discomfort increases with activity and subsides
             during rest
       Care
            Refer to physician for assessment and X-ray
            Rest for 2-5 months
   Avulsion Fractures
       Cause of Injury
            Avulsions seen in sports w/ sudden
             accelerations and decelerations
       Signs of Injury
            Sudden localized pain w/ limited movement
            Pain, swelling, point tenderness
       Care
            Rest, limited activity and graduated exercise
End of Presentation

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