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The Hip _ Thigh

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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

				
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