chapter 14 pelvis, hip, and thigh conditions
DESCRIPTION
Chapter 14 Pelvis, Hip, and Thigh Conditions. Anatomy. Skeletal features of the pelvis, hip, and thigh. Anatomy (cont’d). Pelvis Function Protects organs Transmits loads between trunk and lower extremity Provides site for muscle attachments. Anatomy (cont’d). Pelvis (cont’d) - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/1.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 14
Pelvis, Hip, and Thigh Conditions
Chapter 14
Pelvis, Hip, and Thigh Conditions
![Page 2: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/2.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy Anatomy Skeletal features of the pelvis, hip, and thigh
![Page 3: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/3.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Pelvis
– Function
• Protects organs
• Transmits loads between trunk and lower extremity
• Provides site for muscle attachments
![Page 4: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/4.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Pelvis (cont’d)
– 4 fused bones
• Sacrum
• Coccyx
• Innominate bones
• Ilium, ischium, and pubis
![Page 5: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/5.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Pelvis (cont’d)
– SI joint
• Critical link between the two pelvic bones
• Strong ligamentous support
– Sacrococcygeal joint
• Fused line symphysis united by a fibrocartilaginous disc
![Page 6: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/6.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Pelvis (cont’d)
– Pubic symphysis
• Interpubic disc located between the two joint surfaces
• Femur
– Weakest at femoral neck
![Page 7: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/7.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Hip Joint
– Head of femur and acetabulum of pelvis
– Ball and socket joint
– Very stable
![Page 8: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/8.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Hip Joint (cont’d)
– Strong ligament support
• Iliofemoral ligament
• Limits hyperextension
• Pubofemoral ligament
• Limits abduction and hyperextension
![Page 9: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/9.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)• Hip Joint (cont’d)
– Strong ligament support (cont’d)
• Ischiofemoral ligament
• Limits extension
Ligaments of the pelvis and hip
![Page 10: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/10.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Femoral Triangle
– Borders
• Inguinal ligament—superior
• Sartorius—lateral
• Adductor longus—medial
![Page 11: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/11.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Femoral Triangle (cont’d)
– Contents
• Femoral nerve
• Femoral artery
• Femoral vein
Femoral triangle
![Page 12: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/12.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Bursae
– Iliopsoas
• Reduces friction between iliopsoas and articular capsule
– Deep trochanteric bursa
• Provides cushion between greater trochanter and gluteus maximus at its attachment to iliotibial tract
![Page 13: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/13.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Bursae (cont’d)
– Gluteofemoral bursa
• Separates gluteus maximus from origin of vastus lateralis
– Ischial bursa
• Weight-bearing structure during sitting
• Cushions ischial tuberosity where it passes over gluteus maximus
![Page 14: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/14.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Nerves
– Lumbar plexus
• Femoral nerve
• Obturator nerve
– Sacral plexus
• Sciatic nerve
![Page 15: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/15.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy (cont’d)Anatomy (cont’d)
• Blood Vessels
– External iliac
• Femoral
• Deep femoral
• Femoral circumflex
![Page 16: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/16.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Kinematics and Major Muscle ActionsKinematics and Major Muscle ActionsMuscles of the pelvis, hip, and thigh. Anterior view
![Page 17: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/17.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Kinematics and Major Muscle Actions (cont’d)Kinematics and Major Muscle Actions (cont’d)Muscles of the pelvis, hip, and thigh. Lateral view
![Page 18: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/18.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Kinematics and Major Muscle Actions (cont’d)
Kinematics and Major Muscle Actions (cont’d)
Muscles of the pelvis, hip, and thigh. Posterior view
![Page 19: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/19.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Kinematics and Major Muscle Actions (cont’d)
Kinematics and Major Muscle Actions (cont’d)
• Hip flexors
– Iliopsoas, pectineus, rectus femoris, sartorius, and tensor fascia latae
– Two-joint muscles
• Rectus femoris—active during hip flexion and knee extension
• Sartorius—active during hip flexion and knee extension
![Page 20: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/20.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Kinematics and Major Muscle Actions (cont’d)
Kinematics and Major Muscle Actions (cont’d)
• Hip extensors
– Gluteus maximus and hamstrings (biceps femoris, semitendinosus, and semimembranosus)
• Hamstrings—two-joint; hip extension and knee flexion
![Page 21: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/21.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Kinematics and Major Muscle Actions (cont’d)
Kinematics and Major Muscle Actions (cont’d)
• Hip abductors
– Gluteus medius, gluteus minimus
– Active in stabilizing pelvis during single-leg support and during support phase of walking and running
• Hip adductors
– Adductor longus, adductor brevis, and adductor magnus
![Page 22: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/22.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Kinematics and Major Muscle Actions (cont’d)
Kinematics and Major Muscle Actions (cont’d)
• Lateral rotators
– Piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, and quadratus femoris
– Lateral rotation of femur of swinging leg accommodates lateral rotation of pelvis during stride
![Page 23: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/23.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Kinematics and Major Muscle Actions (cont’d)
Kinematics and Major Muscle Actions (cont’d)
• Medial rotators
– Gluteus minimus
– Tensor fascia latae, semitendinosus, semimembranosus, gluteus medius, and adductors
![Page 24: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/24.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Kinematics and Major Muscle Actions (cont’d)Kinematics and Major Muscle Actions (cont’d)
PRIMARY ACTION
MUSCLES
Flexion Iliopsoas; rectus femoris; pectineus; sartorius; tensor fasciae latae
Extension Gluteus maximus; biceps femoris; semitendinosus; semimembranosus; adductor magnus
Abduction Gluteus medius; gluteus minimus
Adduction Adductor brevis; adductor magnus; adductor longus; adductor magnus; gracilis
Medial rotation Gluteus minimus; gluteus medius; tensor fasciae latae; semitendinosus; semimembranosus; adductor muscles
Lateral rotation Piriformis; obturator internus; obturator externus; superior gemelli; inferior gemelli; quadratus femoris; gluteus maximus
![Page 25: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/25.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Kinematics and Major Muscle Actions (cont’d)
Kinematics and Major Muscle Actions (cont’d)
• Hip joint – movement in 3 planes
– Sagittal
• Flexion and extension
– Frontal
• Abduction and adduction
– Transverse
• Medial rotation and lateral rotation of the femur
![Page 26: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/26.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Injury PreventionInjury Prevention
• Physical conditioning
– Flexibility
– Strength
• Protective equipment
– Hip joint well protected but iliac and pelvis need protection
– Thigh
• Shoe selection
– Cushion forces
![Page 27: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/27.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Contusions Contusions
• Hip pointer
– MOI: direct blow to iliac crest
– S&S
• Any trunk movement is painful (incl. coughing, laughing, & breathing)
• Immediate pain, discoloration, spasm, and loss of function
• Unable to rotate trunk or laterally flex the trunk toward injured side.
![Page 28: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/28.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Contusions (cont’d)Contusions (cont’d)
• Hip pointer (cont’d)
– S&S (cont’d)
• Any trunk movement is painful
• Extreme tenderness
• Abdominal muscle spasm may be present
• Severe injury – unable to walk or bear weight, even with crutches
![Page 29: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/29.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Contusions (cont’d)Contusions (cont’d)
• Hip pointer (cont’d)
– Management
• Standard acute; rest; protect with hard-shell pad for return to activity
• Severe pain over iliac crest – physician referral
![Page 30: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/30.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Contusions (cont’d)Contusions (cont’d)
• Quadriceps contusion
– MOI: direct blow
– Common – anterolateral thigh
– S&S
• Pain may be extensive immediately after impact
![Page 31: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/31.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Contusions (cont’d)Contusions (cont’d)
• Quadriceps contusion (cont’d)
– S&S (cont’d)
• Grade I
• Mild pain and swelling
• Able to walk without a limp
• Passive flexion beyond 90° – painful; resisted knee extension may cause less discomfort.
![Page 32: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/32.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Contusions (cont’d)Contusions (cont’d)
• Quadriceps contusion (cont’d)
– S&S (cont’d)
• Grade II
• Can flex the knee between 45 and 90°
• Walks with a noticeable limp
• Grade III
• Unable to bear weight or fully flex the knee.
![Page 33: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/33.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Contusions (cont’d)Contusions (cont’d)
• Quadriceps Contusion (cont’d)
– Management:
• Standard acute; with knee in maximum flexion
• Hard-shell pad for return to activity
• Physician referral if S&S persist >48 hours
![Page 34: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/34.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Contusions (cont’d)Contusions (cont’d)
• Quadriceps contusion (cont’d)
Management of a quadriceps contusion
![Page 35: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/35.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Contusions (cont’d)Contusions (cont’d)
• Myositis ossificans
– Develops secondary to single significant blow or repetitive blows to same area
– Evident on radiograph 3–4 weeks after injury
Myositis ossificans
![Page 36: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/36.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Contusions (cont’d)Contusions (cont’d)
• Myositis ossificans (cont’d)
– S&S
• Warm, firm, swollen thigh; 2–4 cm larger
• Palpable, painful mass may limit passive knee flexion to 20–30°
• Active quadriceps contractions and straight leg raises—difficult
– Management: standard acute; physician referral
![Page 37: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/37.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bursitis Bursitis • MOI
– Excessive friction orshear forces due to overuse
• Greater trochanteric bursitis
– Influence of Q-angle
Bursa of the hips
![Page 38: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/38.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bursitis (cont’d)Bursitis (cont’d)
• Greater trochanteric bursitis
– S&S
• Burning or aching over or posterior to greater trochanter
• Aggravated with:
• Hip abduction against resistance
• Hip flexion and extension on weight bearing
![Page 39: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/39.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bursitis (cont’d)Bursitis (cont’d)
• Iliopsoas bursitis
– Pain medial and anterior to joint; cannot be easily palpated
pain with passive hip rotation; resisted hip flexion, abduction, and external rotation
![Page 40: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/40.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bursitis (cont’d)Bursitis (cont’d)
• Ischial bursitis
– Pain aggravated by prolonged sitting and uphill running,
– Point tenderness directly over ischial tuberosity
pain with passive and resisted hip extension
![Page 41: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/41.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bursitis (cont’d)Bursitis (cont’d)
• Bursitis management
– Do not permit to continue activity until seen by a physician
– Suggest cold to decrease pain and inflammation
![Page 42: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/42.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bursitis (cont’d)Bursitis (cont’d)
• Snapping hip syndrome
– Can result from chronic bursitis
– S&S
• Snapping sensation heard or felt during hip motion, especially with lateral rotation and flexion while balancing on one leg
• Iliopsoas bursa affected—snapping in medial groin
![Page 43: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/43.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bursitis (cont’d)Bursitis (cont’d)
• Snapping hip syndrome (cont’d)
– Management
• Do not permit to continue activity until seen by a physician
• Suggest cold to decrease pain and inflammation
![Page 44: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/44.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip Sprains and DislocationsHip Sprains and Dislocations
• MOI
– Violent twisting actions
– With hip and knee flexed to 90°, force through shaft of femur
• S&S
– Mild/moderate: pain with internal rotation
– Severe: intense pain; inability to move hip
– Position of flexion and internal rotation
![Page 45: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/45.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip Sprains and Dislocations (cont’d)Hip Sprains and Dislocations (cont’d)
• Management
– Mild/moderate—standard acute; physician referral
– Severe—activate EMS; immobilize in position found – do not move; monitor and treat for shock
![Page 46: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/46.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip DislocationsHip Dislocations
Hip dislocations
![Page 47: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/47.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains Strains
• Quadriceps
– Typically rectus femoris
– S&S
• Grade I
• Normal gait, but tightness in the anterior thigh
• Pain with passive knee flexion beyond 90°
![Page 48: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/48.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains (cont’d)Strains (cont’d)
• Quadriceps (cont’d)
– S&S (cont’d)
• Grade II
• Snapping or tearing sensation, followed by immediate pain and loss of function.
• Knee held in extension – protection
• Pain with passive knee flexion; Pain & weakness with knee extension
![Page 49: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/49.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains (cont’d)Strains (cont’d)
• Quadriceps (cont’d)
– S&S (cont’d)
• Grade III strains
• Extreme pain
• Ambulation not possible
• Defect in the muscle may be visible
• Resisted knee extension not possible; ROM is severely limited
![Page 50: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/50.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains (cont’d)Strains (cont’d)
• Hamstrings
– Initial swing—flex knee; late swing—eccentrically contract to decelerate knee extension and re-extend hip in prep for stance phase
– Overemphasis on stretching without strengthening
– Additional risk factors (Box 14.2)
– Strength imbalance
![Page 51: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/51.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains (cont’d)Strains (cont’d)
• Hamstrings (cont’d)
– S&S
• Grade 1
• Tightness and tension
• Pain with passive stretching
![Page 52: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/52.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains (cont’d)Strains (cont’d)
• Hamstrings (cont’d)
– S&S (cont’d)
• Grade II
• Tearing sensation or feeling a “pop,” leading to immediate pain and weakness in knee flexion.
![Page 53: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/53.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains (cont’d)Strains (cont’d)
• Hamstrings (cont’d)
– S&S (cont’d)
• Grade III
• Sharp pain may occur during midstride
• Limps; unable to do heel-strike or fully extend the knee.
• Pain and muscle weakness with active knee flexion
![Page 54: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/54.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains (cont’d)Strains (cont’d)
• Adductors
– Quick changes of direction, and explosive propulsion and acceleration
– Strength imbalance
![Page 55: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/55.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains (cont’d)Strains (cont’d)
• Adductors (cont’d)
– S&S
• An initial “twinge” or “pull” of the groin muscles, and is unable to walk because of the intense, sharp pain
• As the condition worsens, increased pain, stiffness, and weakness in hip adduction and flexion
![Page 56: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/56.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains (cont’d)Strains (cont’d)
• Adductors (cont’d)
– S&S (cont’d)
• Running straight ahead or backward may be tolerable, but any side-to-side movement leads to more discomfort and pain
• Pain with passive stretching with the hip extended, abducted, and externally rotated
• Pain with resisted hip adduction
![Page 57: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/57.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains (cont’d)Strains (cont’d)
• Predisposing factors
– Beginning of season – too much too soon
– Fatigue
– History of strains; reinjury common
– Restricted flexibility of involved muscle group
![Page 58: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/58.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strains (cont’d)Strains (cont’d)
• Management:
• Grade 1 – standard acute; If symptoms persist > 2-3 days, physician referral
• Grade 2 or 3 – standard acute; physician referral
![Page 59: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/59.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Vascular and Neural DisordersVascular and Neural Disorders
• Legg-Calvé-Perthes disease
– Avascular necrosis of proximal femoral epiphysis
– Seen especially in males ages 3–8
– Osteochondrosis of femoral head
![Page 60: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/60.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Vascular and Neural DisordersVascular and Neural Disorders
• Legg-Calvé-Perthes disease (cont’d)
– S&S
• Gradual onset of limp and mild hip or knee pain of several months in duration
• Pain is generally activity related
ROM in hip abduction, extension, and external rotation due to spasm in hip flexors and adductors
![Page 61: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/61.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Vascular and Neural Disorders (cont’d)Vascular and Neural Disorders (cont’d)
• Legg-Calvé-Perthes disease
– Management
• Do not permit to continue activity until seen by a physician
![Page 62: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/62.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip FracturesHip Fractures
• Avulsion fractures
– Due to rapid, sudden acceleration and deceleration
– Apophyseal sites
• ASIS with displacement of sartorius
• AIIS with rectus femoris displacement
• Ischial tuberosity with hamstrings displacement
• Lesser trochanter with iliopsoas displacement
![Page 63: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/63.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip Fractures (cont’d)Hip Fractures (cont’d)
• Avulsion fractures (cont’d)
– S&S
• Sudden, acute, localized pain—may radiate down muscle
• Swelling and discoloration
• Palpable gap between tendon attachment and bone
pain with AROM, PROM, RROM of involved muscle
![Page 64: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/64.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip Fractures (cont’d)Hip Fractures (cont’d)
• Avulsion fractures (cont’d)
– Management: fit with crutches; immediate physician referral
![Page 65: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/65.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip Fractures (cont’d)Hip Fractures (cont’d)
• Slipped capital femoral epiphysis
– Boys ages 12–15
– Femoral head slips at epiphyseal plate—displaces inferiorly and posteriorly
Slipped capital femoral epiphysis
![Page 66: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/66.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip Fractures (cont’d)Hip Fractures (cont’d)
• Slipped capital femoral epiphysis (cont’d)
– S&S
• Early S&S often undetected other than diffuse knee pain
• Later stages
• More comfortable holding leg in slight flexion
![Page 67: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/67.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip Fractures (cont’d)Hip Fractures (cont’d)
• Slipped capital femoral epiphysis (cont’d)
• Later stages
• Unable to touch the abdomen with the thigh because the hip externally rotates with flexion
• Unable to rotate the femur internally or stand on one leg.
– Management: Do not permit to continue activity until seen by a physician
![Page 68: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/68.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip Fractures (cont’d)Hip Fractures (cont’d)
• Stress fractures
– Pubis, femoral neck, and proximal one-third of femur
– Risk factors
![Page 69: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/69.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip Fractures (cont’d)Hip Fractures (cont’d)
• Stress fractures (cont’d)
– S&S
• Diffuse or localized aching pain in anterior groin or thigh during weight-bearing activity, relieved with rest
• Night pain
• Antalgic gait may be present
![Page 70: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/70.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hip Fractures (cont’d)Hip Fractures (cont’d)
• Stress fractures (cont’d)
– S&S (cont’d)
• ↑ pain on extremes of hip rotation, abduction lurch
• Inability to stand on involved leg
– Management: Do not permit to continue activity until seen by a physician
![Page 71: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/71.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sacral and Coccygeal FracturesSacral and Coccygeal Fractures
• Rare in sports
• Direct blow to area due to fall on buttock
• S&S: extremely painful; unable to sit
• Management: immediate referral to a physician
![Page 72: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/72.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Femoral Shaft FractureFemoral Shaft Fracture
• MOI
– Tremendous impact forces
– Direct compressive forces
• Potential for neurovascular damage
![Page 73: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/73.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Femoral Shaft Fracture (cont’d)Femoral Shaft Fracture (cont’d)
• S&S
– Severe pain and a total loss of functions
– Swelling at fracture site
– Present with the thigh externally rotated
– Shortened limb deformity
![Page 74: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/74.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Femoral Shaft Fracture (cont’d)Femoral Shaft Fracture (cont’d)
• Management
– Activate emergency plan, including summoning of EMS
– Do not attempt to immobilize
– Assess and treat for shock as necessary
![Page 75: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/75.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Femoral Fractures (cont’d)Femoral Fractures (cont’d)
• S&S
– Previous history of femoral stress fracture ↑ risk of complete fracture
– Extreme pain and inability/unwillingness to move involved side
– Shock
![Page 76: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/76.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Femoral Fractures (cont’d)Femoral Fractures (cont’d)
• S&S (cont’d)
– Neck
• Individual supine, lower extremity in external rotation and abduction; appears shortened compared with other side
– Shaft
• Limb appears shortened; thigh appears externally rotated
![Page 77: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/77.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Femoral Fractures (cont’d)Femoral Fractures (cont’d)
• Management
– Activate EMS
– Assess distal vascular integrity
– Monitor and treat for shock
– Defer immobilization until emergency medical personnel arrive (traction splint will typically be applied)
– NPO—possible surgical intervention
![Page 78: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/78.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Coach and Onsite AssessmentCoach and Onsite Assessment
• S &S that require activation of emergency plan, including summoning EMS
– Obvious deformity suggesting a dislocation or fracture
– Significant loss of motion or loss of function
– Palpable defect in a muscle
– Severe joint disability that may be evident by a noticeable limp
![Page 79: Chapter 14 Pelvis, Hip, and Thigh Conditions](https://reader035.vdocuments.net/reader035/viewer/2022062409/56814f7e550346895dbd2eba/html5/thumbnails/79.jpg)
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Coach and Onsite Assessment (cont’d)Coach and Onsite Assessment (cont’d)
• S &S that require activation of emergency plan, including summoning EMS
– Excessive soft tissue swelling, particularly in the quadriceps
– Abnormal cutaneous sensations or an absent or weak pulse
• Refer to Application Strategy 14.2