Lecture 7 - Thigh, Hip, & Pelvis

Question 1

What are the 4 bones of the hip?

Answer 1

• femur
• innominates
• sacrum
• coccyx

Question 2

What are the 3 ligaments of the hip?

Answer 2

• ischiofemoral ligament
• pubofemoral ligament
• illiofemoral ligament
• all end up under the head of the femur increasing stability

Question 3

What is the ischiofemoral ligament?

Answer 3

• located posterior & superior to the articular capsule
• prevents excessive internal rotation & adduction of the thigh

Question 4

What is the pubofemoral ligament?

Answer 4

• located anterior & inferior
• prevents excessive abduction of the thigh

Question 5

What is the iliofemoral ligament?

Answer 5

• considered the strongest ligament of the body
• Runs from the anterior iliac spine to the intertrochanteric line on the anterior part of the femur
• prevents hyper-extension, limits external rotation & adduction

Question 6

What are the muscles of the hip?

Answer 6

• quadriceps & hamstrings
• adductors - pectineus, adductor longus/brevis/magnus
• abductors - gluteus minimus/medius
• lateral rotators - piriformis, obturator internus/externus, superior/inferior gemelli
• medial rotators - gluteus minimus/medius, & adductor longus/brevis/magnus

Question 7

What are the 3 nerves of the thigh? What do they Innervates?

Answer 7

• Sciatic Nerve - Innervates posterior thigh
• Femoral Nerve - Innervates anterior thigh
• Obturator Nerve - Innervates the adductor group

Question 8

What are the main movements at the hip?

Answer 8

• flexion-extension
• abduction-adduction
• internal-external rotation
• circumduction

Question 9

What are 5 common injuries & conditions of the hip?

Answer 9

• anterior thigh contusion (layman’s Charlie horse)
• hip pointer (contusion of iliac crest)
• coccyx contusion
• trochanteric bursitis
• muscle strains

Question 10

What is an anterior thigh contusion (layman’s Charlie horse)?

Answer 10

• a bruising of the quadriceps muscles caused by a direct blow, leading to pain, swelling, and bruising
• Most contusions are mild in nature but as the magnitude of the force increases so does the damage
• Signs & Symptoms: as per loss of ROM & Function
• Treatment: PIER, should be done with knee flexed
• Protection when returning to activity

Question 11

What is a hip pointer?

Answer 11

• contusion (bruise), of the iliac crest, often caused by a direct blow or impact to the hip area
• Periostitis of the crest occurs
• Aggravated by almost all torso motion due to the attachment of the abdominal obliques at this point
• Treatment: PIER, Pad for protection

Question 12

What is a coccyx contusion?

Answer 12

• Results from a direct blow during a fall onto the buttocks
• A very debilitating injury that can take weeks to heal
• Treatment: Ice & Rest, sit on an inflatable ring cushion

Question 13

What is trochanteric bursitis?

Answer 13

• lateral hip pain thought to be caused by inflammation of the trochanteric bursa
• Cause: Direct Trauma & Rubbing or tensor fascia latae over the bursa may be exacerbated by gluteus Maximus where if tight can increase the tension in the TFL

Question 14

What are muscle strains?

Answer 14

• an acute or chronic soft tissue injury that occurs to a muscle, tendon, or both
• Most common areas are the hamstrings & Groin muscles
• Cause: excess strain as in eccentric loading
• When muscle strains are close to the insertion points on the pelvis be wary of avulsion fractures

Question 15

How can hamstring strains occur?

Answer 15

• Most common in sprinters, football running backs, or any other athlete where sudden acceleration is required

Question 16

How can groin strains occur?

Answer 16

• Seen when there is a sudden abduction, external rotation & extension of the thigh
• Common in soccer & hockey

Question 17

What is an avulsion fracture?

Answer 17

• occurs when a ligament or tendon pulls a small piece of bone away from the main bone, often due to sudden forceful movements or injuries

Question 18

What are 4 common sites for avulsion fractures?

Answer 18

• Ischial Tuberosity (Hamstrings)
• ASIS (Sartorius)
• AIIS (Rectus Femoris)
• Pubic Ramus (Adductors)

Question 19

What is an ASIS avulsion fracture?

Answer 19

• the sartorius & tensor fascia lata muscles, which attach to the ASIS, pull a piece of bone away from the iliac crest

Question 20

What is an ischial tuberosity avulsion fracture?

Answer 20

• Repeated contractions of the hamstrings can cause the piece of the ischial tuberosity pull away from the rest of the bone

Question 21

What is an AIIS avulsion fracture?

Answer 21

• occurs when the rectus femoris pulls a fragment of the AIIS away from the bone
• occurs from sudden, forceful rectus femoris contractions, especially during activities requiring quick hip bending & knee straightening

Question 22

What is a pubic ramus avulsion fracture?

Answer 22

• occurs from sudden, forceful contractions of muscles that attach to the pubic ramus, such as the adductor muscles

Question 23

What are hip joint sprains?

Answer 23

• The hip Joint suffers very few sprains due to the integrity of the bones & the size of the ligaments
• Sacroiliac Joint is injured from a fall onto the hip or landing on a single leg flat footed or on the heel

Question 24

What is the treatment of hip & thigh injuries?

Answer 24

• Acute: Always insure an accurate assessment to discern the extent of the injury then follow standard protocol:
• PIER 24-48 hours, Heat & other modalities, Maintain ROM & Cardiovascular system, Restore Flexibility & Functional ROM, Strength emphasis on closed Kinetic Chain, Proprioception, Psychological Preparation, Protection via tape support or functional stabilizer