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The Hip & Thigh Chapter 17 Hip & Thigh Anatomy- Skeletal - thigh bone; longest & strongest bone ◦ Greater Trochanter ◦ Lesser ___________________ ◦ Neck ◦ Head- articulates with the acetabulum to form the hip joint Hip & Thigh Anatomy- Skeletal ____________________- hip girdle made up of three bones ◦ Ilium Iliac _____________________ Anterior Superior Iliac Spine Anterior Inferior Iliac Spine Posterior Superior Iliac Spine Posterior Inferior Iliac Spine Hip & Thigh Anatomy- Skeletal (pelvis cont.) ◦ _______________________ Obturator Foramen- hole in between the pubis and ischium Acetabulum- connects with the head of the femur to form the hip joint ◦ _____________________ Ischial Tuberosity Hip & Thigh Anatomy- Connective Extremely strong ligaments hold the head of the femur into the acetabulum _________________ Ligament- ilium to femur Pubofemoral Ligament- pubis to femur Ischiofemoral _____________- ischium to femur Ligamentum Teres- attaches the head of the femur to the acetabulum inside the joint Hip & Thigh Anatomy- Connective Joint Capsule- surrounds the _______ and aids in stability Acetabular Labrum- thick ring of cartilage that surrounds the ______________ to make the “socket” deeper Hip & Thigh Anatomy-Muscular Movements at the hip ◦ Flexion / Extension ◦ Abduction / Adduction ◦ Internal / External Rotation Attachments: ◦ _______________- where the muscle begins; usually proximal ◦ _________________- where the muscle connects; usually distal Hip & Thigh Anatomy- Muscular Quadriceps Muscle- large anterior muscle that provides knee extension & hip flexion; quad = ____ parts ◦ 1) Rectus Femoris ◦ 2) Vastus Medialis ◦ 3) _____________ Intermedius ◦ 4) Vastus Lateralis Hip & Thigh Anatomy- Muscular _______________ Femoris (part of the quad) Action: hip flexion, knee extension Origin: anterior superior iliac spine (ASIS) Insertion: tibial tuberosity via the patellar tendon _________________- longest muscle in the body Action: hip flexion, hip internal rotation, hip abduction, knee extension Origin: anterior superior iliac spine Insertion: pes anserine Hip & Thigh Anatomy- Muscular Psoas Action: hip flexion Origin: lumbar vertebrae Insertion: lesser ____________ Iliacus Action: hip flexion Origin: internal iliac crest Insertion: lesser trochanter ________________- formed by the joining of the psoas and iliacus muscles Hip & Thigh Anatomy- Muscular Gracilis Action: hip adduction, knee flexion Origin: ___________ bone Insertion: pes anserine Pectineus Action: hip _____________ Origin: pubic bone Insertion: medial femur (proximal) Hip & Thigh Anatomy- Muscular ________________ Brevis Action: hip adduction, internal rotation Origin: pubic bone Insertion: medial femur (proximal) Adductor Longus Action: hip adduction, internal rotation Origin: ________________ bone Insertion: medial femur (middle) Hip & Thigh Anatomy- Muscular Adductor Magnus Action: hip adduction, internal rotation Origin: pubic bone Insertion: medial femur (distal) Hip & Thigh Anatomy- Muscular Hamstring Group- group of three posterior muscles that flex the knee ◦ 1) Biceps _________________ Action: hip extension, knee flexion Origin: ischial tuberosity (pelvis) Insertion: fibular head ◦ 2) ______________________ Action: hip extension, knee flexion Origin: ischial tuberosity Insertion: pes anserine Hip & Thigh Anatomy- Muscular ◦ 3) Semimembranosus Action: knee flexion, hip extension Origin: ischial tuberosity Insertion: medial condyle of the tibia Gluteus Maximus, Medius & Minimus Action: hip ____________, external rotation Gluteus medius also aids in abduction Hip & Thigh Anatomy- Muscular Tensor Fascia Lata Action: hip abduction Origin: anterior superior iliac spine Insertion: lateral tibia via IT Band ◦ ________________ Band- tendinous band that connects the tensor fasica lata to the lateral tibia Prevention of Hip & Thigh Injuries Hip and thigh are thick with muscle, bone, and ligaments and thus are generally well protected Most injuries are due to muscle imbalances ◦ Hamstrings should have 60-75% strength of the quad ◦ Hamstrings should be regularly _____________ to maintain proper flexibility Prevention of Hip & Thigh Injuries ◦ Core muscles in the ______________ and low back also need to be considered to maintain proper balance at the hip Acute Injuries of the Hip & Thigh Quadriceps ______________- frequent contusion site due to its location ◦ Muscle gets compressed against the femur ◦ Signs & Symptoms- Ecchymosis, swelling, point tenderness, limp, loss of range of motion and strength ◦ Management- PRICE – ice with knee in flexed position Crutches may be necessary Heat should never be applied!!!! Acute Injuries of the Hip & Thigh Gentle static stretching Isometric exercises when tolerable Padding should be applied when athlete returns to activity Acute Injuries of the Hip & Thigh ____________ Ossificans- bone formation in the muscle secondary to a contusion ◦ Bleeding in the muscle forms a blood tumor ◦ Irritated tissue may produce calcium formations that resemble bone ◦ Signs & Symptoms- Pain, loss of range of motion, palpable contusion/tumor, takes __-__ weeks before it will show on an x-ray Acute Injuries of the Hip & Thigh ◦ Management- Crutches Refer to _______________ Surgery may be necessary in severe cases Acute Injuries of the Hip & Thigh Quadriceps ______________- muscle strain caused by a sudden stretch or sudden contraction ◦ Signs & Symptoms- Pain, point tenderness, spasm, loss of function, and __________________; deformity may be noted with a complete tear ◦ Management PRICE – crutches if necessary Refer to physician for complete ruptures Acute Injuries of the Hip & Thigh Hamstring Strain- caused by a quick change from knee stabilization to hip extension ◦ ______________ common thigh muscle strain ◦ May be the result of muscle fatigue, faulty posture, muscle imbalance, improper form, or _________________ tightness Acute Injuries of the Hip & Thigh ◦ Signs & Symptoms- Internal bleeding, pain, loss of function Grade ___- muscle soreness, point tenderness, stiffness Grade II- partial tearing, severe pain, loss of function with knee flexion Grade III- complete rupture, major bleeding, disability, palpable and visual defect May also involve an avulsion fracture at the ischial tuberosity (origin) Acute Injuries of the Hip & Thigh ◦ Management- PRICE- crutches may be necessary Activity limitations will depend on severity; explosive movements, deceleration, and direction changes should be avoided initially Static stretching and isometrics should be utilized Referral to a physician should be made for grade III strains Acute Injuries of the Hip & Thigh Groin Strains- most often due to running, jumping, and twisting with external rotation ◦ Athletes who are out of shape with _____ strength & flexibility are at ______ risk ◦ Signs & Symptoms- Pain, weakness, ecchymosis Acute Injuries of the Hip & Thigh ◦ Management- PRICE Emphasis on rest Groin Spica Persistent pain should be referred to a physician to rule out a pelvic stress fracture Acute Injuries of the Hip & Thigh Femur ___________- rare in sports, but may be caused by great blunt trauma such as falling from a height or being directly hit by another player or equipment ◦ Most frequently occurs in the middle 1/3 of the _________ Acute Injuries of the Hip & Thigh ◦ Signs & Symptoms- Severe pain, major internal bleeding, muscle spasms, and swelling Deformity- bone displacement because of tight & strong quad Thigh externally rotated Shortened apperance Shock will likely be a factor Acute Injuries of the Hip & Thigh ◦ Management- Call EMS Support the limb / vacuum splint Treat for shock Acute Injuries of the Hip & Thigh _________ Sprain- caused by a violent twist mechanism; may be due to collision with another person or object ◦ Signs & Symptoms- Inability to circumduct, hip pain, increased pain with hip rotation Acute Injuries of the Hip & Thigh ◦ Management- PRICE; especially crutches if ____________ bearing weight X-ray to rule out fracture ROM and strengthening exercise can begin when pain free Acute Injuries of the Hip & Thigh Hip _____________- caused by traumatic force up the length of the bone while the knee is in a bent position ◦ May also be caused by falling on the side of the hip ◦ Hip dislocations are very rare due to the strength of the connective tissue ◦ Generally the femur dislocates ___________ Acute Injuries of the Hip & Thigh ◦ Will likely involve tearing of the ligaments and capsule ◦ A fracture may also occur with dislocation ◦ Damage to the sciatic nerve and nutrient artery may also be present May lead to avascular ____________ ____________ Necrosis- death of an area caused by lack of circulation Acute Injuries of the Hip & Thigh ◦ Signs & Symptoms- Hip will be in a position of flexion, adduction, and internal rotation Palpation may reveal that the head of femur is resting ____________ to the acetabulum ◦ Management- Call EMS Immobilization ____ weeks of bed rest Use of crutches/walker for 4-6 weeks Acute Injuries of the Hip & Thigh ◦ Complications Paralysis may occur due to nerve damage Degeneration of the femoral head Acute Injuries of the Hip & Thigh _______ Crest Contusion (Hip Pointer)- caused by blunt trauma to the iliac crest ◦ Usually occurs on the ASIS ◦ Signs & Symptoms Pain, point tenderness, muscle guarding, ecchymosis Pain with hip flexion and trunk rotation ◦ Management Cryotherapy and pressure for _____ hours Acute Injuries of the Hip & Thigh ◦ Management _______________ and pressure for 48 hours X-ray to rule out fracture Bed rest or crutches may be necessary Protective padding on return to play Acute Injuries of the Hip & Thigh Avulsion Fracture- sudden forceful contraction causes the tendon to pull __________ from the bone ◦ Common sites include: ASIS – sartorius or rectus femoris Ischial tuberosity- hamstring Acute Injuries of the Hip & Thigh ◦ Signs & Symptoms Localized pain, swelling, and point tenderness ◦ Management Rest, limited activity, graduated exercise Chronic Injuries of the Hip & Thigh Stress Fractures- most common in the neck of the femur or the inferior pubis ◦ Caused by repetitive abnormal use or drastic increases in intensity ◦ More common in women especially those who are _______________ (no period) ◦ Signs & Symptoms Aching, constant pain that increases with activity _____________ with rest Chronic Injuries of the Hip & Thigh ◦ Management RICE, refer to physician for X-ray, 2-5 months rest ROM and strengthening may be added in later Chronic Injuries of the Hip & Thigh Piriformis Syndrome- tightness or spasm in the piriformis muscle compresses the sciatic nerve ◦ Often misdiagnosed as __________ (nerve is compressed by lumbar spine) ◦ Signs & Symptoms _____________ and tingling in the butt that may extend to the leg Pain that worsens with sitting for a long time, climbing stairs, walking, and/or running Chronic Injuries of the Hip & Thigh ◦ Management Rest and stretch Corticosteroid injection or surgery may be necessary in severe cases Evaluation of the Hip & Thigh History ◦ What happened? ◦ What’s hurt?: “Point with One Finger” ◦ When did it happen? ◦ Did you _______ or feel anything unusual? ◦ Has the structure been injured before? ◦ What movements cause the pain? ◦ Does the pain radiate? ◦ How bad is the pain? – Scale ___-___ ◦ What type of pain is it? Evaluation of the Hip & Thigh Observation Gait, posture, compensation Gross deformity- dislocation, visible __________ Swelling ____________ (bruising) Bleeding Skin color Evaluation of the Hip & Thigh Palpation ◦ Femur ◦ * take special care Greater Trochanter when palpating in the ◦ Ilium groin and buttocks Anterior Superior Iliac areas Spine Iliac Crest ◦ Quadriceps Group ◦ Ischium ◦ Hamstring Group* Ischial Tuberosity* ◦ Gluteus Group* ◦ Sacrum* ◦ Groin Muscles* ◦ Coccyx* ◦ Sartorius ◦ Tensor Fascia Lata IT Band Evaluation of the Hip & Thigh Special Test ◦ AROM , PROM , RROM Hip flexion / extension Hip abduction / adduction Hip internal / external rotation Evaluation of the Hip & Thigh ◦ _____________ Test- tests for hip flexor tightness Patient lies supine Examiner passively flexes one hip and knee while the other remains straight Positive if the straight hip lifts off of the table Evaluation of the Hip & Thigh ◦ ___________ Test- tests for tensor fascia lata / IT Band tightness Athlete lies on unaffected side With knee bent it is passively abducted and extended The leg is then allowed to drop back to normal position Positive if the hip doesn’t drop past parallel
"The Hip _ Thigh"