Hip & Groin Flashcards
Sciatic nerve innervates ________
posterior thigh
Femoral nerve innervates _______
anterior thigh
obturator innervates ________
adductor group
how would you do an assessment of hip
- history (any neural pain?)
- observation (gait; walking, running)
- assessment (flexion, extension, abduction, adduction, internal, external rotation)
injury prevention for hip and groin
- protective equipment (thigh pads/girdles; athletic cups; neoprene braces/sleeves)
- shoes (cushion forces)
- physical conditioning (mm strength, endurance & flexbility)
true or false; hip sprains are very rare
true
potential acute hip and groin injuries
- contusions
- myositis ossificans
- strains (quadriceps, hamstring, adductor, groin, hip flexor)
- sprains (RARE)
- fractures (femoral)
- hip dislocation
potential chronic/overuse injuries for hip and groin
femoral stress fracture
contusions - quad - etiology
- exposed to blunt trauma
- contusions usually develop as a result of severe impact & resultant muscular compression
- extent of force and degree of thigh relaxation determine depth and functional disruption that occurs
1st degree contusion
- little or no pain
- mild hemorrhaging
- no swelling
- mild point tenderness
- no disability in ROM
2nd degree contusion
- mild pain
- mild swelling
- mild to moderate hemorrhaging
- mild point tenderness
- mild disability
- limping
3rd degree contusion
- moderate pain
- moderate swelling
- moderate disability
- obvious limping
4th degree contusion
- severe pain
- severe swelling
- severe disability
- potential mm herniation
- obvious limp or unable to weight bear
S&S contusions - quad
- localized pain, bleeding, swelling & temporary loss of function - weakness (extending or flexing knee) ; graded 1-4 superficial to deep
management of contusions - quad
- POLICE
- NSAIDS
- ROM and stretching ex
- protect upon return to play
- no massage or heat initially
- recommended during rehab
myositis ossificans - etiology
- formation of ectopic bone following direct blow, repeated blunt trauma, or improper care of thigh contusion
S&S myositis ossificans
- pain, weakness, swelling, point tenderness, decreased ROM & function
- X ray shows deposits 2-6 weeks following
management of myositis ossificans
- manage conservatively
- regain ROM
- physician referral
contusions - hip pointer - etiology
- direct blow to iliac crest or abdominal musculature
S&S contusions - hip pointer
- pain
- spasm
- swelling
- transitory paralysis of soft structures
- decreased rotation of trunk or thigh/hip flexion
hip pointer - contusion - management
- POLICE for 48 hours
- ice massage
- protection upon RTP
- may need physician referral to rule out fracture
1st degree strain
- limited swelling and tightness
- near normal gait
- mild point tenderness & discomfort during palpation
- soreness during movement
- < 20% fibers torn
2nd degree strain
- pain and swelling noted on palpation
- may note on palpable divot
- pain with resisted mm testing
- limping
- mm spasms
- <70% of fibers torn
3rd degree strain
- rupturing tendinous or mm tissue
- major hemorrhage & edema
- major disability and loss of function
- pain and palpable defect or mass
- > 70% fibers torn
quadriceps strain - etiology
- suddens tretch, or violent forceful contraction of hip and knee into flexion or knee flexion with hip in extension
S&S quad strain
- pain
- spasm
- swelling and delayed bruising
- loss of function
- decrease ROM
- decrease strength of extensors
quad strain - management
- POLICE
- crutches and wrap
- later use of sleeve
- progress to pain free ROM, isometrics, and stretching
- may require 12 weeks RTP
hip flexor strain etiology
- sudden overstretch into hyperextension
S&S hip flexor strain
- pain, swelling, delayed bruising and disability
- decrease ROM and extensor strength
management hip flexor strain
- POLICE
- crutches and hip spica wrap
- note direction of pull
ham strain etiology
- eccentric load in hip flexion and knee extension
- sudden explosive contraction or direction change/acceleration/decceleration
- other factors: fatigue, posture, leg length discrepancy, imbalances, ham dominance, mm tightness
S&S ham strain
- pain, swelling, delayed bruising, spasms, loss of range and function
management - ham strain
- POLICE
- crutch
- wrap
- conservative treatment with gradual ROM and strengthening
adductor strain - etiology
- overstretch into abduction
- abduction, and external rotation and hip extension
- running, jumping, twisting w/ ER
management - adductor strain
- POLICE
- rest is key
- hip spica wrap
legg-calve perthes disease
- affects 10-17 / boys>girls
- disrupts circulation to femoral head -> necrosis
Slipped capital femoral epiphysis
- affects 10-17 boys > girls; idiopathic
- often those very tall and thin or obese
S&S LCP; SCFE
- groin pain associated with a trauma (25% of time) or slow onset over weeks/months as a result of stress; limited range and limp
LCP may refer into the ______ or ______
abdomen or knee
hip dislocation - etiology
- rare in sports
- posterior dislocation when traumatic force applied along long axis of femur (eg., seated)
S&S hip dislocation
- flexed, adducted, and internally rotated thigh
- deformity, pain, mm spasms, neurological issues
management hip dislocation
- call 911 ; immediate medical care (blood and nerve supply may be compromised)
- immobilization and crutch use
femoral fracture - etiology
- significant trauma; fall from height
- direct blow
- avascular necrosis
S&S femoral fracture
- swelling
- pain
- deformity (shorter appearance)
- mm guarding
- hip slight adduction and ER
femoral fracture - management
- call 911
- treat for shock
- verify neurovascular status and vitals
- splint before moving
femoral stress fracture - etiology
- overuse (10-25% of all stress fractures)
- endurance athletes; excessive downhill running or jumping activities
- female athlete triad
S&S femoral stress fracture
- persistent pain in thigh/groin;
- antalgic gait (ie., limp) which increases during activity
- loss of glut medius stabilization
management of femoral stress fracture
- prognosis will vary depending on location (femoral neck vs shaft)
osteitis pubus - etiology
- repetitive stress on pubic symphysis and adjacent mm
- seen in distance runners, soccer, football, and wrestling
S&S osteitis pubis
- pain in groin, and pubic symphysis
- point tenderness
- pain with running
- sit ups and squats pain
management of osteitis pubis
- rest, NSAID
- gradual RTP
true or false; joint mobilization must be done passively
false; can be done actively
