lecture 8- hip, thigh, pelvis, genitalia Flashcards
Pubis symphysis
=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
Hip ligaments (capsule)
Iliofemoral
Ischiofemoral
Pubofemoral
–> each of these restrict certain movements of the hip to prevent from moving too far in one direction
Hip Bursae
Iliopsoas bursa= between iliopsoas muscle and anterior joint capsule
Trochanteric bursa= between greater trochanter of femur and glute max
Strain and strain of the hip
Hx: violent torsion or extension. Hip flexion vs resistance (iliopsoas strain)
SSx: deep pain, worse w movement
Tx: rest, NSAID, physio
Subluxation vs “snapping hip”
Snapping hip is not serious (clicking/popping of the hip w movement)
- Iliopsoas tendon sliding over the greater trochanter
Subluxation is more
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
Hip dysplasia
Often in infants
Shallow acetabulum
Tx: immobilize in a brace for 6 weeks
Bursitis of the hip
= 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
Labral tear
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
3 main causes of a labral tear
- Trauma (ex. MVA)
- Hip abnormalities (hip dysplasia. FAI= femoral acetabulum impingement= acetabulum too big)
- Repetitive movements (twisting, extreme end range movements, repetitive joint loading)
Fracture/Dislocation of hip
Hx: severe trauma, or elderly person
SSx: extreme pain, reduced ROM, deformity?
Tx: stabilize, transport (NPO)
Thigh: 2 nerves
femoral (L2-L4 nerve root) and sciatic (L4-S3 nerve root)
Thigh artery
femoral
Thigh bone
femur
Sartorius
very long muscle,
helps w hip flexion
Thigh contusion
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
Myositis ossificans
- Several contusions or mishandling of severe contusions
- ROM not returning after quad contusion
- Thigh firm to palpation weeks to months later
- Send for imaging
Thigh strain
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
Hamstring strains
Causes= inflexible, improper warmup, temp, fatigue, violent contractions
Tx= POLICE, rest, stretching, delayed strengthening (eccentric), gradual RTP, hamstring tensor wrap/core shorts!!!
Iliotibial band friction syndrome (ITBFS)
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?)
Femoral Fracture (thigh)
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
Scrotal contusion
Pain gone in 5 min
Tx: hip flexion, gentle breathing
Traumatic hydrocoele
Delayed complication of contusion (days, weeks, months)
Cluster of swollen veins
May need surgery
Torsion of spermatic cord
Pain increases over time!!
Swelling, tenderness
Shock, nausea, vomiting
Emergency (NPO, transport for surgery)