Pelvis, Hip & Thigh Conditions Flashcards
Bones of the hip and thigh (6)
femur
sacrum
coccyx
ilium
ishium
pubis
joint articulations of the hip (2)
head of femur
acetablum of innominate
Bones of the femur (6)
greater trochanter + head & neck
shaft of femur
medial & lateral condyle of femur
Bones of pelvis (12)
crest of ilium
fossa of ilium
anterior spine of ilium
ilium (main)
ishium (main)
superior ramus of pubis
inferior ramus of pubis
pubis (main)
sacroiliac joint
coccyx
acetabulum
obturator foramen
what is the acetabulum made up of (3)
ilium pubis ishium
ligaments of the pelvis (2)
inguinal ligamnet
posterior sacroiliac ligament
anterior muscles of the pelvis (5)
psoas major
iliacus
piriformis
gracilis
quadriceps:
- rectus femoris
-vastus lateralis
-vastus medialis
- vastus intermedius
posterior muscles of the pelvis (5)
glute max
glute min
glute med
Bicep femoris: short & long head
muscles of the pelvis: lateral rotators (6)
glute max
piriformis
superior gemellus
inferior gemellus
quadricep femoris
obturator internus
What is another name for the lateral hip rotators + their function as a group
also called the deep 6
-keeps head of the femur in hip joint & stabilizes the hip
nerves of the pelvis (plexus, their nerves and what they innervate)
Lumbar plexus:
- femoral nerve (innervates anterior thigh)
- obturator nerve (innervates adductor group)
Sacral plexus:
-Sciatic nerve (innervates posterior thigh)
blood supply to the pelvis: 3 main arteries
deep circumflex femoral
deep femoral
femoral artery
Important functional anatomy of the Thigh (4)
- quads insert in a common tendon to the proximal patella
- Rect. fem. is the only quad muscle that crosses the hip (extends knee & flexes hip)
- Important to distinguish between hip flexors relative to injury for both treatment & rehab program
- Hamstring cross the knee joint posteriorly and all cross the hip (except short head of bicep femoris)
quadricep contusion (charlie horse): etiology
-most common site is anterolateral thigh
-MOI: direct blow to the thigh
quad contusion: S/S & management
S/S:
-painful with Ely’s test (beyond 90 degrees of passive flexion)
-pain w/resisted knee extension (no pain with passive knee extension)
-limp
-swelling may prevent full flexion
management:
- 24-48 hr ice & compression
-begin passive & active stretching/strength
-continued swelling dispite care can indicate continued hemmorrhage and needs doctor refferal
how should you compression wrap a quad contusion
With knee in complete flexion, wrap the ice to the bruise and the tensor wrap is wrap around the quad and lower leg with knee bent and heel to the butt. This is to preserve the ROM
quad strain: etiology
-Possible avulsion fracture on proximal attachment of the anterior inferior iliac spine
MOI:
-violent forceful contraction of hip with knee into flexion
-sudden stretch of quad
Quad strain: S/S
-follows normal muscle strain grades
-painful passive knee flexion
-Grade 2/3 may report snapping or tearing
-isometric contraction may reveal muscle bulge
Increased pain & weakness in:
- active knee extension
-passive knee flexion
-resisted knee extension
Quad strain: Management (Grade 1,2,3)
Grade 1:
-tensor bandage for compression
-RICE, gentle stretching, ROM & progressive strength
Grade 2:
-Ice/compress 3-5 days & gradual increase to isometric strength
-pain free ROM
-limit passive stretching until later stages in healing
Grade 3:
-crutch for 7-14 days
-Restore normal gait before progressive rehab
-continued compression for support
-may take 12+ weeks
Hamstring strain: Etiology
MOI:
-rapid contraction (hip extension + knee flexion)
-violent stretch (hip flexion)
what factors increase your risk of hamstring injuries? (7)
poor flexibility
poor posture
muscle imbalance
improper warm up
muscle fatigue
previous injury
overuse
Hamstring strain: S/S
-follow muscle grading outline
-complain of ongoing tension or tightness
-grade 2/3 complains of tearing or popping sensation
-limps
-cannot fully extend knee
-noticable defect in muscle belly
Hamstring strain: Increased pain & weakness in which ROM
- active knee flexion + hip extension (w/extended knee)
- passive knee extension + hip flexion
- resisted knee flexion
what sports are hamstring strains most common in?
sprinting, football running backs, soccer (any athlete that requires sudden acceleration)
hamstring strain: Management (grade 1,2,3)
Grade 1:
-do not resume activity until function is fully restored
Grade 2 & 3:
- treated conservatively
-gradually return to stretching & strength in later stages
-recovery may take months to 1 year.
Adductor (groin) strain: Etiology
MOI:
-quick changes of direction
-explosive propulsion & acceleration
-strength imbalance between abductors & adductors
Where are adductor strains most common?
Typically occur at the proximal attatchment at the pubic ramus
Adductor strain: S/S
-follows general muscle grading outline
-athlete will complain of a twinge/pull sensation
-unable to walk in severe cases & intense sharp pain
Adductor strain: Increased pain & weakness in what ROMs
-active hip adduction + hip internal rotation
-passive hip abduction + hip external rotation
-Resisted hip adduction + hip internal rotation
Adductor strain: Management
-RICE, NSAIDs & analgesics for 48-72hr
-determine exact muscle(s) involved
-rest & daily whirlpool/cryotherapy
-no exercise until pain free
-restore normal ROM and strength-provide support with wrap
Hip dislocation: Etiology
MOI:
-direct traumatic force along long axis of the femur
-Posterior dislocation w/hip flexed & adducted & knee flexed
Hip dislocation: S/S
-flexed, adducted & internally rotated
-palpation reveals displaced femoral head posteriorly
-soft tissue damage, neurological damage and possible fracture, possible internal hemorrhage
Hip dislocation: management
-immediate medical care (911 call)
-2 weeks immobilization and crutches for 1 month
Hip pointer: Etiology
-contusion of the iliac crest with an associated hematoma
MOI:
-direct blow to area
Hip pointer: S/S general
S/S
-aggravated by almost all torso motion to due attachment of abdominal obliques + coughing/breathing
-pain w/lateral flexion on injured side
-immediate pain, discolouration & swelling
-extreme tenderness on palpation
Hip pointer: Management
-Rice for 48 hours, NSAIDs
-Xray to rule out fracture
-mild stretching and icing reduces secondary muscle spasms
-crutches may be neccessary
-fitted donut pad when returning to play
Hip pointer: Grade 1 S/S
-normal gait
-slight pain on palpation
-little/no swelling
-full trunk ROM
-3-7 days before return to activity
Hip pointer: Grade 2 S/S
-abnormal gait
-slightly flexed posture towards injured side
-pain on palpation of iliac crest and swelling
-painful & limited trunk ROM & pain in lateral flexion to opposite side of injury
-return to activity may take 5-14 days
Hip pointer: Grade 3 S/S
-severe pain, swelling & bruising
-slow gait, short stride and swing through
-posture severely tilted to injured side
-painful and limited trunk ROM
-return to activity may take 14-21 days
