Injuries of the Hip Thigh and Groin Flashcards
what is a plica?
piece of fibrous tissue extending from joint capsule that is supposed to be absorbed during growth and development that sometimes gets left over and interferes with the joint
Where does the sartorius originate?
ASIS
Where does the rectus femoris originate?
AIIS
Where do hamstrings originate?
Ischial tuberosity
What muscles are in the hamstrings?
Biceps femoris (long and short), semitenidnosus, and semimembranosus
Where do external obliques originate?
outer surfaces of the ribs
Where do external obliques insert?
Anterior 1/2 of iliac crest and medially on linea alba
what is the action of the external obliques?
trunk rotation, flexion, side bending, and compressing abdominal viscera
What muscles are the hip flexors?
PP SIR
Psoas major/minor
Pectineus
Sartorius
Iliacus
Rectus femoris
all assisted by tensor fascia latae
what is special about the rectus femoris?
It is the only quad muscle that does hip flexion
What are the 4 quadriceps muscles?
Rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis
what are the hip adductors?
PAAAG
Pectineus
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Where does sartorius originate?
ASIS
Where does sartorius insert?
Medial proximal tibia as it is part of pes anserine group
What is the acetabular labrum?
fibrous cartilage that rims acetabulum and deepens the socket while increasing the stablity of the joint.
Has limited blood supply
What is a hip pointer injury?
A contusion of the iliac crest (specifically the periosteum that has alot of sensory nerves)/ Often results in external obliques and tensor fascia latae being affected as well as atheletes report pain with forced exhalation and bowel movements (function of external obliques)
What is the MOI of a hip pointer injury
Blunt trauma to the iliac crest
What are S and S with Hip pointer injury?
pain with trunk flexion, rotation, side bending/hip flexion, brusing and swelling over iliac crest, and muscle spasms
What is the acute management for a hip pointer injury
PIER (with pressure pad if tolerated) and lympth drainage to settle any spasms
What is RTP post hip pointer injury
donut pad with cover - possibly hip flexor wrap if hip flexion is affected
What is MOI for acetabular labral tear?
Acute plant and twist or hyperabduction (ie splits), overuse degeneration
What are S and S for acetabular labral tears?
pain, clicking/catching in hip or groin, decreased hip ROM< audible pop/sensation at time of injury, “C” sign descriptor of pain
what is the special test for an acetabular labral tear?
Scouring test
What is acute managment for acetabular labral tear?
ice, rest, pain managment
what are next steps in injury rehab of acetabular labral tear?
focusing on correct mechanics (ie building stable base - core and hip stability) and increasing proprioception. Refer to surgery in pain and mobility treatment isn’t effective
What does a scouring test test for?
hip labrum tears, capsulitis, oseteochondral defects (ie bone and cartilage defects), acetabular defects, osteoarthritis, avascular necrosis, and femoral acetabular inpingement syndrome`
what is capsilitis
inflammation of capsule leading to scar tissue
what is avascular necrosis?
bone death from decreased blood supplt
what is femoral acetabular impingement syndrome?
irregular shape of one or both joint surfaces of acetabulym leading to labrum/cartilage tears
What is MOI for ITB friction syndrome?
overuse from friction over lateral femoral condyle (by the knee) caused by continuous knee flexion and extension. Glute med weakness often contributes
Next steps for ITB injury
Check Glut med and see if strengthening will help
Check foorwear and wear patterns - maybe a change in gate or shoe will help
What is MOI for hipflexor tendonitis
overuse and repetitive flexion
What is special test for hip flexor tendonitis?
Thomas test (lie on table, one leg bent, other leg straight- if leg is at 180 degrees, ++)
what are S and S for hip flexor tendonitis
pain with active and resisted hip flexion, stretch pain with passive hip extension, tendorness on palpation to hip flexor (PP SIR) tendons
what is acute management for hip flexor tendonitis
ice, rest/altered activity, hip flexor wrap
What is MOI for hip flexor strain?
forceful hip extension and/or leg caught in hip extension
What is MOI for quad strain
forceful quad contraction or hip extension with knee flexion
What is MOI for hamstring strain
Excessive hip flexion with extended knee or eccenteric hamstring contraction in late stance phase of sprinting
What is MOI for hip adductor strain?
quick cutting (overstretch with forceful contraction) or splits type motion
what is a grade 1 muscle strain?
tissue is stretched, some fibers are disrupted, contractions are strong but painful
What is a grade 2 muscle strain?
partial tear with many fibers disrupted, contractions are weak and painful
What is a grade 3 muscle strain
complete tear, unable to contract and often pain free as nerve fibers were torn
What are some S and S for strains of hip and thigh?
pull or pop sensation upon injur, weakness (for grade 2 and 3 strain), bruising due to increase blood supply (for grade 2 and 3 strain)
what is acute management for hip and thigh strains?
PIER (pressure pad with wrap over affected tissues), non weight bearing if unable to walk normally, hip flexor/adductor wrap for daily wear if needed, lymph drainage to help with bruising, and educate so no reinjury
What is RTP for hip and thigh strain?
Hip flexor/adductor wrap as needed
What is MOI for thigh contusion?
blunt trauma
What is S and S for thigh contusions
discolouration and muscle weakness (possibly)
contusion means
bruise
what are thigh contusions at risk for?
myositis ossificans (calcium deposit around bruise causing muscle to become hard)
What is acute management for thigh contusion?
effleurage/lymph drainage, ice, NO DEEP TISSUE MASSAGE, protective padding with donut pad
What is RTP for thigh contusion?
80% strength, FULL ROM, and able to do demands of sport without compensation
how do you do a tomas test?
lie with back on table, one leg bent toward chest, other leg coming off the table.
Neg test: hamstring touch table, knee in approx 80 degrees of flexion, food straight (not rotated)
Positive test: hip flexion (ie leg can’t be flat on table) - + for hip flexor tension
hip flexion with knee extension (ie leg can’t be flat on table and leg is straight) + for rectus femoris
Hip abducted (inwards); tight iliotibia band
rotated tibia: tight ITB
What is the noble compression test?
tests for iliotibial band syndrome (common overuse injury)
steps:
athelete lies on back with leg bent at 90
apply compression to lateral epicondyle and straighten leg
+ = pain
How do you do a resisted mscle test for the psoas?
athelete lays on back, 30 degrees hp flexion, 10 degrees abduction, and slight external rotation
therapist stabilizes opposite side of pelvis
Therapist tries to pul athelete into extension, athelete matches pressure to stay in original position
How do you do resisted muscle testing for the rectus femoris?
athelete sits with hip and knee art 90 (like in a chair), bring thigh into flexion
therapist applies pressure downwards into hip extension - athelete resists pressure to maintian original position
How do you do resisted muscle testing for short adductors
athelet lies in crook position (supine with knees bent and feet on table)
therapist abducts with hands on knee and athelete matches pressure
How do we do resisted muscle testing for long adductors
athelete lies supine table
therapist abducts with hands on ankles and athelete matches pressure
hip extensor resisted muscle testing
athelte lies in prone position with 30 degrees hip extension, athelete holds
therapist applies pressure to put hip into flexion and athelete resisted
What is resisted muscle testing for isolate glutes
athelete in prone position with hip extension and knee flexed to 90 - they try to hold
therapist tries to apply pressure into flexion - athelete resists!
what is resisted muscle testing for hamstrings
athelete lies prone with 90 degrees knee flexion
medial ham - tibia is rotated internally
lateral ham - tibial is rotated externally
therapist applies pressure into knee extension and athelete resists
why is glute med weakness important to treat?
glute med weakness is a common cause of aligment problems down the chain
How do we test posterior fibers of glute medius?
post fibers control internal rotation of femur in weight earing
athelte start lying on non affected side, hip is in slight extension and external rotation
therapist, applying pressure at ankle, tries to push the hip into adduction
athelete resists
Resisted muscle testing grade 0
no visible or palpable contraction
resisted muscle testing grade 1
can see/feel contraction but there is no motion
What is kendall’s resisted muscle test grade 2
muscle has full range of motion without gravity
What is kendall’s resisted muscle test grade 3
gull range of motion against gravity
What is kendall’s resisted muscle test grade 4
full ROM against gravity can fight moderate resistance
what is kendall’s muscle testing grade 5
full ROM against gravity, can fight max resistance
How is a quad/hamstring wrap with pressure pad done
start with load through muscle being wrapped, put pad on affected area, using herringbone tensor technique from distal to proximal, finish with pro/ultralight elastic taoe to secure
