Hip & thigh injuries Flashcards
muscle strains - MOI
- explosive concentric contraction
- quick start/stop, change of direction
- eccentric contraction - lengthening; some muscles do two different actions simultaneously at two different joints
- overstretching
contributing factors: fatigue, pelvic asymmetry, strength imbalance, leg length discrepancy, muscle tightness
muscle strains can occur acutely or chronically, why?
-can become a chronic issue if there is no rest, during the repair process, scar tissue forms (creates a weak point in muscle)
muscle strains: S&S
- point tenderness with a palpable spasm
- possible palpable defect or divot
- bruising may or may not be present
- pain increases with AROM or IR testing
- PROM painful at end ROM when on stretch
- level of dysfunction or disability depends on severity of the injury
grade 1 muscle strain
minimal, few fibers torn, minor swelling
grade 2/3 muscle strain
complete rupture, more edema than grade 1
quadriceps muscle strain
- most common in rectus femoris
- possible avulsion fracture of AIIS
- vulnerable when hip extended and knee flexed
hamstrings muscle strain
- most commonly strained muscle in the body
- vulnerable with hip flexion and knee extension
- deceleration of leg swing
adductor muscle strains
- adductor longus most commonly injured
- adductor magnus presents similar to hamstring pain
hip flexor muscle strain
- sprinting or kicking MOI (unplanar movement)
- often tight due to seated posture
which special test is used to determine hip flexor muscle strains?
Thomas test (for hip flexors and quads) -looking to see where the quad is lying; someone with tight hip flexors will be above horizontal plane
initial management for muscle strain
- POLICE - tensor wrap/compression shorts, activity modification but early return to walk (want to engage muscle a bit; avoid intense activities)
- should not RTP until full ROM and strength - will feel a lot better before they actually have the strength needed to return
what types of therapy can be used to manage muscle strains after the initial treatment
- initially - gentle stretching, ROM and early contraction activation (isometric)
- address underlying causes (pelvis, muscle asymmetries)
- later - strengthening and functional exercises (eccentric and plyometric)
- testing in controlled environment before RTP
severe strain or rupture may require surgical intervention (grade 3)
quadriceps contusion MOI
direct blow to anterior or anterolateral thigh
-compression force between soft tissue and femur
S&S of quadriceps contusion
transitory loss of function/weakness and immediate bleeding; increased pain with AROM knee extension and hip flexion; PROM of knee flexion limited
which special test is used to diagnose quad contusion?
Ely’s test
-look at quad length; prone, bend person’s knee and see what happens at hip, if hip hikes up - tension in the quad; if hip is neutral, good length of quad
management of quad contusion
- POLICE - put the knee in max flexion and crutches - prevent stiffness, heal in length position
- therapy - gentle stretching and ROM (avoid soft tissue therapy - massage; RTP - pad and protect)
what is a secondary complication of a quadriceps contusion?
myositis ossificans
sciatica - def
any condition that causes irritation to the sciatic nerve including disk herniation in the low back, direct trauma (ex: hard fall), piriformis muscle compression
the sciatic nerve is a continuation of the _____ and travels through the _____
sacral plexus, greater sciatic notch
the sciatic nerve passes through the piriformis in ___% of the population
15
S&S of piriformis syndrome
- deep, dull ache in mid-buttock without pain
- numbness and tingling may extend down back of thigh and leg (further it travels down, the more severe it is considered)
- pain on palpation of sciatic notch/piriformis
- NEED to rule out disc herniation (straight leg raise test, coughing)
management of piriformis syndrome
- stretching, massage (trigger point or STRP - soft tissue release) (abduction, internal rotation)
- acupuncture has been known to provide relief from symptoms
hip dislocation MOI
- rare in sports
- traumatic force along the long axis of the femur when knee is flexed (MVA)
S&S of hip dislocation
-flexed, adducted, and internal rotated thigh
secondary complications of hip dislocation
capsular and ligamentous strains, fractures, sciatic nerve impingement, disruption of femoral head blood supply
management of hip dislocation
911 monitor vitals, treat shock and immobilize in position found
therapy for hip dislocation
immobilization (bed rest), crutches, progressive ROM exercises
labral tear MOI
- acute: hip dislocation
- chronic: increased joint stresses (deep squats) or repetitive movements cause degeneration
S&S of labral tear
- commonly asymptomatic
- catching, locking, or clicking in hip
- pain in hip/groin
- stiffness/limited ROM
what are the special tests to diagnose labral tears?
- FABER (flexion, abduction, external rotation)
- flex-IR
- scouring
management for labral tears
- hip ROM, strengthening and stability exercises
- avoid painful movements/positions
- surgery to remove or repair
avascular necrosis - def
temporary or permanent loss of blood to proximal femur
causes of avascular necrosis
- hip dislocation
- lateral circumflex artery compromised
Legg-Calve-Perthes disease
- children 4-10 years
- boys more often than girls
- disruption to circulation to head of femur, articular cartilage necrotic and flattens
S&S of avascular necrosis
- gradual onset pain
- initially only with WB, progresses to even when at rest
- pain in groin, with referral to abdomen and knee (kinetic chain)
- limited ROM and antalgic gait (limp)
management of avascular necrosis
- NWB (bed rest or hip brace, if caught early)
- early treatment = femur vascularizes and re-ossifies
- complications = femur remains deformed, develop OA (later in life), and surgical repair
which type of bursitis is most common?
trochanteric
bursitis - MOI
-excessive friction or shear forces (repetitive stress) or direct blow (not a lot of muscle here)