The thigh, hip, groin, and pelvis Flashcards
What bones make up the general anatomy of the thigh, hip, groin, and pelvis?
Femure, innominates(pelvic girdle), sacrum and coccyx.
Where are the joint articulations of the hip/groin?
head of the femur, acetabulum of innominate.
what ligaments make up the hip?
ischiofemoral, pubofemoral, iliofemoral
where is the ischiofemoral ligament?
located posterior & superior to articular capsule.
What is the purpose of the ischiofemoral ligament?
prevents excessive internal rotation & adduction of the thigh
Where is the pubofemoral ligament?
anterior and inferior
what does the pubofemoral ligament do?
prevents excessive abduction of the thigh
What is the iliofemoral ligament considered and where does it attach?
considered strongest ligament in body;
runs from ASIS to intertrochanteric line on the anterior part of femur
What is the purpose of the iliofemoral ligament?
prevents hyper-extension and limits external rotation and adduction.
Where are the bursae of the thigh, hip and groin located?
iliopsoas- reduces friction between iliopsoas and articular capsule
deep trochanteric bursa- provides cushion between greater trochanter and gluteus maximus at its attachment to iliotibial tract
gluteofemoral bursa- separates gluteus maximus from origin of vastus lateralis
ichial bursa- weight bearing structure; cushions ischial tuberosities.
What muscles make up the medial compartment of the thigh?
pectineus, adductor magnus, adductor brevis, adductor longus, and gracilis.
What muscles make up the anterior compartment of the thigh?
sartorius, quadriceps femoris, vastus intermedius, rectus femoris, vastus lateralis, and vastus medialis.
What muscles make up the hamstring group?
Biceps femoris: long head & short head, semitendinosus and semimembranosus
What are the nerves of the thigh?
femoral nerve, obturator nerve, sacral plexus.
How does the hips, thigh and groin receive blood supply?
3 arteries: deep circumflex femoral, deep femoral, femoral
2 veins: superficial great saphenous, femoral
Where to the quadriceps insert?
common tendon to the proximal patella
which quad muscle crosses the hip? What does it do?
rectus femoris; extends the knee and flexes the hip
What are bi-articulate muscles?
The muscles cross two joints and produce forces dependent on position of the knee and hip
with functional testing when would you not perform AROM, PROM, RROM?
with a fracture
What can you expect during AROM for a strain or partial rupture?
decreased ROM and pain or weak and pain free.
What will you notice during functional testing for PROM?
swelling or spasms will restrict motion
What can you expect during functional testing of RROM if there is a fracture or 3rd degree sprain?
muscle weakness against isometric resistance suggesting nerve injury
What causes quadriceps contusions? how are they determined?
traumatic blunt blow; extent of force determines depth and functional disruption
What is an example of a quad contusion? MOI, S&S, and Management?
AKA: charlie horse
MOI- direct blow to thigh, compressing muscle against bone
SS- localized pain, bleeding, swelling & temporary loss of function-weakness.
Mgmt: PIER( knee flexion), protect (crutches), NSAIDs, therapy for pain, ROM & stretching exercises. protect upon RTP. DO NOT MASSAGE/HEAT
What are symptoms of a 1st degree contusion?
little or no pain mild hemorrhaging no swelling mild pt. tenderness no disability in terms of ROM
what are symptoms of a 2nd degree contusion?
mild pain mild swelling mild to moderate hemorrhaging mild point tenderness mild disability (>90 knee flexion) limping
what are S&S for 3rd degree contusions?
moderate pain and swelling
moderate disability (>45 but <90 of knee flexion)
obvious limping
What are signs and symptoms of 4th degree contusions?
severe pain and swelling
severe disability (<45 of knee flexion)
potential muscle herniation
obvious limp or unable to wt bear.
What is the management for contusions?
PIER, NSAIDs and analgesics
crutches for severe cases
aspiration of hematoma is possible
following exercise or re-injury, continued use of ice
follow up care consists of ROM, and PRE w/in pain free range
myositis ossificants
general rehab is conservative
ice w/ gentle stretching
gradual transition to heat following acute stage
elastic wrapping for support
exercises should be graduated from stretching to swimming to jogging- running
restrict exercise if pain occurs
may require surgery
What is a quad strain?
sudden stretch, violent forceful contraction of the hip and knee into flexion
overstretching of the quads
can be very disabling
What is a MOI for quad strain?
sudden overstretch or sudden, strong contraction
What are S&S of quad strain?
pain, swelling, ecchymosis, spasms and disability.
- decreased ROM & strength of extensors
How do you manage a quad strain?
PIER, protect(crutch/tensor), NSAID and later use of neoprene sleeve
How many grades of a quad strain are there?
3
What are symptoms of a first grade strain?
complain of tightness in front of thigh
near normal ambulation
swelling may be limited;
mild discomfort during palpation
What are symptoms of grade 2 quad strains?
abnormal gain; may be splinted in extension; swelling may be noticeable w pain on palpation possible defect in muscle IR knee extension will reproduce pain
What are symptoms of a grade 3 strain?
possibly unable to ambulate
pain with palpation; may be unable to perform knee extension;
isometric contractions may produce defect or bulging in muscle belly
How do you manage a grade 1 quad sprain?
neoprene sleeve/ tensor wrap to provide added support
how would you manage a grade 2 quad strain?
ice and compression for 3-5 days with gradual increase in isometric exercise and pain free ROM exercises
limited passive stretching until later phases
How would you manage a grade 3 quad strain?
crutches for 7-14 days;
restore normal gait;
compression for support;
may require 12 weeks until returning to full activity
what is the most common thigh injury?
hamstring strain
What are potential causes of hamstring strains?
hamstring/quad contract together;
change in role from hip extender to knee flexor;
fatigue, posture, leg length discrepancy, lack of flexibilty, strength imbalances.
What factors might affect a hamstring strain?
tight muscles, leg length discrepancy, faulty posture, improper form or muscular imbalances.
What are signs and symptoms of hamstring strains?
pain, swelling, eccymosis, spasms and disability (decrease ROM & strength of flexors).
How would you manage a hamstring strain?
PIER, protect, NSAIDs & concentrate of flexibility, modatilites.
How many grades of hamstring strains are there?
3
What symptoms occur in a grade 1 hamstring strain?
soreness during movement;
point tenderness;
<20% fibers torn
What symptoms occur in a grade 2 hamstring strain?
partial tear; identified by sharp snap or tear; severe pain; loss of function; <70% of fibers torn
What are symptoms of a grade 3 hamstring strain?
rupturing of tendinous or muscular tissue;
major hemorrhage and edema;
major disability & loss of function, ecchymosis;
palpable mass or gap;
>70 muscle fiber tearing
How do you manage a grade 1 hamstring strain?
do not resume full activity until complete function restored
how do you manage a grade 2/3 hamstring strain?
should be treated conservatively;
gradual return to stretching and strengthening in later stages of healing;
once pain free, isotonic leg curls can be introduced;
recovery may be required from months to a full year
greater scarring= greater recurrence of injury
What is an adductor/hip flexor strain?
difficult problem to diagnose;
injury to one of the muscles in the regions;
occurs from running, jumping, twisting with hip external rotation or severe stretch
What are S&S of adductor/hip flexor strains?
sudden twinge or tearing during active movement;
produce pain, weakness, and internal hemorrhaging
How do you manage adductor/hip flexor strains?
RICE, NSAIDs & analgesics for 48-72 hrs;
determine exact muscle or muscles involved;
rest is critical; daily whirlpool and cryotherapy, moving into ultrasound;
delay exercise until pain free;
restore normal ROM and strength- provide support with wrap
What causes inflammation at the site where the gluteus medius inserts or the IT band passes over the trochanter?
trochanteric bursitis
What are S&S of trochanteric buristis?
complaint of lateral hip pain that may radiate down the leg;
palpation reveals tenderness over lateral aspects of greater trochanger;
IT-band and TFL tests should be performed
How would you manage trochanteric bursitis?
RICE, NSAIDs and analgesics;
ROM and PRE directed toward hip abductors and external rotators;
must look at biomechanics and q-angle
runner should avoid inclined surfaces.
What causes a dislocated hip?
traumatic force along the long axis of femur.
posterior dislocation with hip flexed and adductors and knee flexed
S&S of hip dislocation:
flexed, adducted and internally rotated hip;
palpation reveals displaced femoral head posteriorly;
serious pathology: soft tissue, neurological damage and possible fracture.
How would you manage a hip dislocation?
immediate medical care (blood and nerve supply may be compromised)
contractures may further complicate reduction
2 weeks immobilization and crutch use for at least one month
What are some pelvic conditions?
pelvic region rotates along longitudinal axis when running, proportionate to the amount of arm swing;
also tilts as legs enage support and non-support;
combination of motion causes shearing changes in lordodic curve throughout activity
What is a hip pointer?
Contusion of iliac crest or abdominal musculature;
results from a direct blow;
aggravated by almost all torso motion due to the attachment of abdominal obliques
S&S of hip pointer:
pain, spasm, and transitory paralysis of soft tissue structures;
decreased rotation of trunk or thigh/hip flexion due to pain
How do you manage hip pointers?
RICE for 48hrs, NSAIDs Bed rest 1-2 days referral for xrays ice massage, ultrasound, occasionally steroid injection recovery 1-3 weeks
