lecture 8- hip, thigh, pelvis, genitalia

Question 1

Pubis symphysis

Answer 1

=syndesmosis joint, tough fibrous joint, connects pubic bones, v little movement except during childbirth

• The bone sticking out when you touch your sides is the trochanter (“hip bone”)
• Pubic symphysis is where everything meets
• The acetabulum is a consists of parts of the ilium, ischium and pubis

Question 2

Hip ligaments (capsule)

Answer 2

Iliofemoral
Ischiofemoral
Pubofemoral

–> each of these restrict certain movements of the hip to prevent from moving too far in one direction

Question 3

Hip Bursae

Answer 3

Iliopsoas bursa= between iliopsoas muscle and anterior joint capsule

Trochanteric bursa= between greater trochanter of femur and glute max

Question 4

Strain and strain of the hip

Answer 4

Hx: violent torsion or extension. Hip flexion vs resistance (iliopsoas strain)
SSx: deep pain, worse w movement
Tx: rest, NSAID, physio

Question 5

Subluxation vs “snapping hip”

Answer 5

Snapping hip is not serious (clicking/popping of the hip w movement)
- Iliopsoas tendon sliding over the greater trochanter

Question 6

Subluxation is more

Answer 6

serious than snapping hip

-Often chronic, may lead to osteoarthritis
-Shallow acetabulum (hip dysplasia) makes it easier for subluxation to occur
-Gymnastics, dancing, martial arts

Tx: rest, exercises, change activity

Question 7

Hip dysplasia

Answer 7

Often in infants
Shallow acetabulum

Tx: immobilize in a brace for 6 weeks

Question 8

Bursitis of the hip

Answer 8

= squeezing of the bursa between the bone and the tendon

Hx: overuse or direct blow, continuous running on one side of the road can contribute (stress on one side and not the other)
–> leg length discrepancies and running on one side of the road can contribute

SSx: tenderness, pain w movement, can be veryyy painful!!!

Tx: POLICE, NSAID, rest, physio

Question 9

Labral tear

Answer 9

Causes: shearing, excessive forces at hip joint
Hip labrum pulls away from acetabulum

SSx: deep, achy groin/buttock pain. Pain and stiffness in certain directions, clicking or locking when moving hip joint

Tx: Exercise is better than surgical treatment

Question 10

3 main causes of a labral tear

Answer 10

1. Trauma (ex. MVA)
2. Hip abnormalities (hip dysplasia. FAI= femoral acetabulum impingement= acetabulum too big)
3. Repetitive movements (twisting, extreme end range movements, repetitive joint loading)

Question 11

Fracture/Dislocation of hip

Answer 11

Hx: severe trauma, or elderly person

SSx: extreme pain, reduced ROM, deformity?

Tx: stabilize, transport (NPO)

Question 12

Thigh: 2 nerves

Answer 12

femoral (L2-L4 nerve root) and sciatic (L4-S3 nerve root)

Question 13

Thigh artery

Answer 13

femoral

Question 14

Thigh bone

Answer 14

femur

Question 15

Sartorius

Answer 15

very long muscle,
helps w hip flexion

Question 16

Thigh contusion

Answer 16

Hx: direct blow

SSx: pain, bruising, swelling, tenderness w palpation, decreased ROM, limp

Tx: POLICE, no heat/massage bc increases bleeding, padding, ROM, physio

–> contusion of compartments
1. Anterior compartment
2. Posterior compartment
3. Medial compartment

Question 17

Myositis ossificans

Answer 17

• Several contusions or mishandling of severe contusions
• ROM not returning after quad contusion
• Thigh firm to palpation weeks to months later
• Send for imaging

Question 18

Thigh strain

Answer 18

Hx: resisting a force, torsion, hyperextension, abduction
Predisposed by decreased strength, flexibility or previous strains

SSx:
1st deg= pain, tenderness, no limp, no snap or pop
2nd deg= pain, tenderness, bruising, limp, snap or pop
3rd deg= (rupture!!) same as 2nd but gap in muscle

Tx:
1st deg= POLICE, ROM, tap
2nd deg= same as 1st, rest for 2-6 weeks, physio, rehab
3rd deg= NPO, stabilize, transport to hospital (surgery), rest, physio, rehab

Question 19

Hamstring strains

Answer 19

Causes= inflexible, improper warmup, temp, fatigue, violent contractions

Tx= POLICE, rest, stretching, delayed strengthening (eccentric), gradual RTP, hamstring tensor wrap/core shorts!!!

Question 20

Iliotibial band friction syndrome (ITBFS)

Answer 20

Pain/tenderness on palpation over lateral epicondyle (highly vascularized)
Pain is not where injury is—distal due to gravity?
Chronic gradual onset

Tx: exercise therapy like PFPS, strengthen hip abductors, release glute max/TFL/vastus lateralis, soft tissue release (dry needle?)

Question 21

Femoral Fracture (thigh)

Answer 21

Major trauma
SSx: severe pain, can’t weight bear
Tx: stabilize, NPO, hospital, surgery,

Rehab= gradual progression of ROM and strengthening to weight bear over 4-6 months

Question 22

Scrotal contusion

Answer 22

Pain gone in 5 min
Tx: hip flexion, gentle breathing

Question 23

Traumatic hydrocoele

Answer 23

Delayed complication of contusion (days, weeks, months)

Cluster of swollen veins

May need surgery

Question 24

Torsion of spermatic cord

Answer 24

Pain increases over time!!
Swelling, tenderness
Shock, nausea, vomiting
Emergency (NPO, transport for surgery)

Question 25

Hip pointer

Answer 25

=Contusion of iliac crest SSx: pain, tenderness, bruising, localized swelling, limp -difficulty flexing thigh or rotating trunk Tx: ice, rest, padding, physio

Question 26

Coccygeal contusion

Answer 26

Fracture of coccyx from a direct blow Need to sit on a donut cushion SSx: pain, bruising, tenderness Tx: Xray, NSAIDs, warm baths, may need surgery