-
Anatomy of the Thigh Hip and Groin
- Bones
- Femur = longest and strongest bone in the body
- -Proximal end articulates with the acetabulum of the pelvis and makes the hip joint
- -Distal end articulates with the tibia to form the knee joint.
- Pelvis = Functions to support the spine and trunk and transfers weight to lower limbs, protects pelvic organs, and is the attachemnt site for trunk and thigh muscles.
-
Composed of:
- Two innominate bones
- -The sacrum
- -coccyx
- Femur
- Pelvic Bones
-
Pelvic Bone Composition
- Sacrum and coccyx
- Illiac Crest
- Sacroilliac joint
- Illium
- Acetabulum (joint location)
- Ishium (inferior posterior of acetabulum)
- Pubic bone (inferior anterior of acetabulum)
- -pubic syphysis (anterior joining of both pelvic bones)
-
Ligaments in the hip
- The head of the femur is stabilized in the acetabulum by iliofemoral ligaments and the joint capusle
- The sacrum is joined to the pelvis via the sacrotuberous and sacrospinal ligaments forming the sacroilliac (SI) joint
-
Muscles of the Hip--Thigh muscles
- Quadriceps muscles--Hip flexors
- Rectus femoris crosses knee joint and hip, so works to flex the hip
- Sartorius flexes the hip and outwardly rotates the thigh
- Hamstring muscles--Hip extensors
- Adductors
- Gracilis
- Pectineus
- Adductor magnus, longus, brevis
-
Hip Flexion Muscles
- Cosnist of 4 muscles
- (Rectus femoris, Sartorius, Illiacus, Psoas)
-
Hip Extension Muscles
Hamstrings (Biceps femoris, Semimembranosus, Semitendonosus)
-
Hip Abductors Muscles
(Gluteus maximus, Gluteus medius)
-
Hip Adductors Muscles
- Tensor fascia lata (TFL)
- Gracilis
- Pectineus
- Adductor magnus
- Adductor longus
- Adductor brevis
-
Hip medial rotation muscle
Gluteus minimus
-
Hip lateral rotation muscles
- Piriformis
- Superior gemellus
- Inferior gemellus
- Obturator internus
- Obturator externus
- Quadratus femoris
-
Evaluating Thigh Hip and Groin Injuries
HOPS
-
History
- What mechanism do you think caused this injury?
- When did you first notice the pain?
- Did the pain begin immediately or did it occur gradually over a period of time?
- Have you had a problem in this area before?
- Has training intensity changed?
- Where is your pain?
- Describe the type of pain. (Sharp, dull, burning, aching)
- Does the pain radiate down the back or the front of the legs or buttocks
- When is the pain worst?
-
Observation
- Postural asymmetry while standing, one legged, and during ambulation
- Anterior view are hips even?
- From the lateral aspect is the pelvis abnormally tilted anteriorly or posteriorly?
- Patellar alignment
- Does standing on one leg cause pain in the hip?
- Observe athlete while walking, bending, and sitting.
-
Palpation
- Iliac crest
- Hip joint
- Femur
- Sacrum
- Coccyx
- Soft tissues of hip
-
Special Tests
- Thomas Test: Looks for tightness in the hip flexors.
- Straight leg raises: Looks for tightness in the hamstrings/hip extensors, Can also indicate SI joint dysfunction and LBP
-
Prevention of Injuries to Thigh Hip and Groin
- Maintain proper flexibiltiy
- Maintain proper strength in hips/Hamstrings/ Quads
- Proper core strength
-
Recognizing Thigh Injuries--Quadriceps Contusions
- Cause of Injury: Traumatic blows
- Signs of Injury
- -Pain
- -Temporary loss of function
- -Immediate bleeding in the muscle
-
Quadriceps Contusions Care Grade 1
- (mild): usually fairly superficial intramuscular bruise.
- -Superficial Contusion
- --Mild hemorrage
- --Minimal pain
- --No swelling
- --Mild point tenderness with no restriction of the ROM
- -Deeper 1st degree contusion
- --Pain
- --Mild swelling
- --TTP
- --Knee flexion less or equal to 90 degree
- walk it off, stretch, and RTP
- ice
-
Grade II (moderate) Quad Contusion
- -Moderate intesity
- --Pain
- --Swelling
- --Knee Flexion < 90 degrees
- --Athlete walks with a limp
- --no RTP
-
Quad Contusions--Grade III (severe)
- Major Disability
- Herniation of the muscle through the fascia can occur (bump on thigh)
- Deep intramuscular hematoma (bleed within muscle)
- Pain is severe
- Swelling is severe and can lead to a hematoma
- Knee flexion is limited to 45-90 degrees
- The athlete has an obvious limp
- Recognizing Thigh Injuries
-
Care of Quad Contusions
- Ice and Compression with the knee flexed
- Gentle static stretch when tolerable
- Crutch walking if a limp is present
- Protective padding
- Quad sets
-
Recognizing Thigh Injuries--Myositis Ossificans
- Myositis Ossificans traumatica = ectopic bone formation within the muscle
- Cause of injury
- --Severe blow or repeated blows to the thigh
- --Attempting to run off a Quad injury
- --Too vigorous treatment of a contusion
-
Myositis Ossificans--Signs of Injury
- Disruption of muscle fibers, blood vessels, connective tissue, and periosteum of femur
- Acute inflammation
- Formation of bone may be noted on x-ray 2-4 weeks after injury
-
Myositis Ossificans--Care
- VERY Conservative treatment
- Removal of bone formation after 1 year
- Recurrent Myositis Ossificans can indicate a problem with blood clotting.
-
Recognizing Thigh Injuries--Quadriceps Muscle Strain Cause of Injury
- --Sudden stretch e.g. falling on a bent knee
- --Sudden contraction: Jumping in volleyball or kicking in soccer.
-
Quadriceps Muscle Strain-Signs of Injury of Peripheral tear
- --Mild point tenderness
- --Mild to no bleeding
-
Quadriceps Muscle Strain- Signs of Injury of Partial muscle tear
- --Mild to Moderate Pain
- --Mild bleeding
-
Quadriceps Muscle Strain--Signs of injury of Deep tear
- --Lots of pain
- --TTP
- --Spasm
- --Loss of function
- --Little discoloration
-
Quadriceps Muscle Strain--Signs of Injury of Complete tear
- --Little disability
- --Little discomfort
- --Deformity of anterior thigh
- --Recognizing Thigh Injuries
-
Quadriceps Muscle Strain--Care
- Rest
- Cold application
- Pressure
- Neoprene sleeve
-
Hamstring Muscle Strains Facts
- This muscle group has the highest incidence of strain.
- Hamstrings should have 60-75% of strength of the Quads
-
Hamstring Muscle Strains--Cause of Injury
- Quick change of function from stabilization to extension of the hip
- Muscle fatigue
- Sciatic nerve irritation
- Faulty posture
- Leg- length discrepancy
- Tight hamstrings
- Improper form
- Muscle strength imbalance
-
Hamstring Strains--Signs of Injury (Grades I-III)
- Grade I
- --Muscle soreness on movement
- --TTP
- Grade II
- --Sudden snap or tear of the muscle
- --Severe pain
- --Loss of function of knee flexion
- --Palpable defect in the muscle
- Grade III
- --Major hemorrhage
- --Disability
- --Palpable, and sometimes visual, defect
-
Hamstring Strains--Care
- RICE
- Decreased Activity
- Avoid ballistic and explosive stretching
- Hamstring strains tend to reoccur because they heal with inelastic fibrous scar tissue.
- The greater the injury the greater the incidence of recurrence.
-
Acute Femoral Fracture--Cause of Injury
- Typically occur in the shaft
- Caused by great force
- Falling from a great height
- Direct hit
-
Acute Femoral Fracture--Signs of Injury
- Shock
- Extreme pain
- Deformity with the thigh rotated outward
- A shortened thigh, cause by bone displacement
- Swelling of soft tissues
-
Acute Femoral Fracture--Care
Immediate EMS assistance and referral to ER
-
Stress Fracture of the Femur--Cause of Injury
- Increase in popularity of jogging and mileage
- Females who are amenorrheic (inconsistent/ no period)
-
Stress Femoral Fracture--Signs of Injury
- Constant pain
- Usually located in the neck of the femur
-
Stress Femoral Fracture--Care
- Rest
- Limited weight bearing
-
Dislocated Hip Joint--Cause of Injury
- Traumatic force along the axis of the femur
- Falling on the side (usually w/knee bent)
-
Disclocated Hip Joint--Signs of Injury
- Thigh is flexed, adducted and internally rotated
- Dislocated Hip Joint--Care
- --Immediate EMS action
- --Immobilization (bed rest) for 2 weeks
- --Crutch walking for 1 month or longer
- Complications
- --Muscle paralysis due nerve injury
- --Degeneration of femoral head
-
Piriformis Syndrome--Cause of Condition
- The sciatic nerve becomes compressed by irritation or tightness and spasm of the piriformis muscle.
- This is NOT sciatica. Sciatica is caused by a herniated lumbar disc pressing on the nerve.
-
Periformis Sybdrome--Signs of Condition
- Pain
- Numbness and tingling in the butt that can run down into the knee and foot.
- Pain can worsen if they are seated for long periods of time/climbing stairs/running/walking
-
Periformis Syndrome--Care
- Stretching
- Massage
- NSAIDs
- Corticosteroid injection
- Rest
-
Cam and Pincer Lesions (femoralacetabular impingment)--Cause of Condition
- Condition caused by an abnormally shaped femoral head, accetabulum or both.
- Common in hockey players and Soccer players
- Diagnosis is one of exclusion--chronic hip injuries
- Treatment is surgery to correct the abnormality
- Cam=abnormal shaped femoral head
- Pincer=abnormal shaped acetabulum
-
Groin Strain--Cause of Injury
- Overextension of the groin musculature
- Running, jumping, twisting w/external rotation
- Usually occurs in early part of the season due to poor conditioning
-
Groin Strain--Signs of Injury
- Sudden twinge of feeling of tearing during movement
- Pain
- Weakness
- Internal bleeding
- --test with sit-ups to determine strain or hernia.
- Groin Strain--Care
- Intermittent ice
- Pressure wrap
- Rest for 48-72 hours
- Spica bandage
- Severe groin pain should be referred to Dr. for medical attention to R/O pelvic fx
-
Athletic Pubalgia/ Sports Hernia--Cause of Injury
- Repetitive movement and trauma especially hip flexion
- Weak abdominal muscles and pelvic floor muscles
- Tight adductors
-
Athletic Pubalgia/Sports Hernia--Signs of Injury
- Pain during activity usually with hip flexor and trunk twisting
- Pain is diffuse and hard to pinpoint but usually refers to the adductors
-
Athletic Pubalgia/ Sports Hernia--Care
- Usually diagnosed via process of elimination
- Surgical repair of hernia as well as possible adductor release
-
Hip Joint Problems in the Adolescent Athlete
- Slipped Capital Femoral Epiphysis
- Legg-Perthes disease (Coxa Plana)
-
Legg-Perthes disease (Coxa Plana)
- Loss of blood circulation to the articular head of the femur.
- Usually occurs in children ages 3-12 and in boys more often than girls.
- The articular cartilage will die and becomes flattened. (Avascular Necrosis)
-
Signs of Coxa Plana
- C/O Pain in the groin that can refer to abdomen or knee
- Usually comes slowly over time
- Exam may show limited hip movement and pain
-
Coxa Plana--Care
- Complete bed rest
- Special Brace
- If treated properly head of femur will revascularize and retain it's normal shape
-
Coxa Plana--Complications
- Osteoarthritis in later life
- Hip Joint Problems in the Adolescent Athlete
-
Slipped Capital Femoral Epiphysis
- Condition in which the epiphysis of the femur slips backward off of the femoral head.
- Usually due to weakness in the growth plate
- Usually occurs in boys 10-17
- Caused by rapid growth
- Might be related to effects of growth hormone
- ? of the cases both hips are affected
-
Slipped Capital Femoral Epiphysis--Signs of Condition
- Pain in the groin area
- During advanced stage major limitations of movement occur
-
Slipped Capital Femoral Epiphysis--Care
- Minor displacement = no weight bearing
- Major displacement = corrective surgery
-
Slipped Capital Femoral Epiphysis--Complications
Severe hip problems may occur later in life
-
Iliac Crest Contusion (Hip Pointer)--Cause of Injury
Blow to the iliac crest
-
Iliac Crest Contusion (Hip Pointer)--Signs of Injury
- Immediate pain
- Muscle guarding
- Transitory paralysis of soft structures
-
Iliac Crest Contusion (Hip Pointer)--Care
- Cold and pressure
- Bed rest in severe cases
- Referral to Dr. for X-rays
- Padding for RTP
-
Osteitis Pubis--Cause of Injury
- chronic inflammation of pubic symphysis
- Running
-
Osteitis Pubis--Signs of Injury
- Pain in groin region and in the pubic symphysis
- TTP on pubic tubercle
- Pain with running sit-ups and squats
-
Osteitis Pubis--Care
- Rest
- NSAIDs
- Gradual return to activity
-
Acute Fracture of the Pelvis--Cause of Injury
Direct trauma
-
Acute Fracture of the Pelvis--Signs of Injury
- Severe pain
- Loss of function
- Shock
-
Acute Fracture of Pelvis--Care
- Treat for shock
- Initiate EMS or refer to Dr.
-
Stress Fracture of Pelvis--Cause of Injury
Repetitive abnormal overuse forces
-
Stress Fractue of Pelvis--Signs of Injury
- Groin pain
- Aching sensation in the thigh that increases with activity and decreases with rest
-
Stress Fracture of Pelvis--Care
- Refer to Dr. for X-ray
- Rest for 2-5 months
-
Avulsion Fracture--Cause of Injury
- Intense forces of the muscle pulls a small piece of the bone away from it's insertion site
- Common sites
- --Sartorius muscle and the ASIS
- --Rectus Femoris muscle and the AIIS
- --Hamstrings and the ischial tuberosity
-
Avulsion Fracture--Signs of Injury
- Sudden localized pain with limited movement
- Swelling and Point tenderness
-
Avulsion Fracture--Care
- Rest
- Limited Activity
- Graduated Exercise
|
|