Thigh, Hip, Groin, and Pelvis

Question 1

Functional Anatomy of the Thigh

Answer 1

• quads I = common tendon to the prox. patella
• Rect Fem = Only quad to cross hip (exten+flex)
• Hamstrings cross the knee joint post. and all except short head of bicep femoris cross hip
• Bi-articulate muscles produce forces dependent on position of the knee and hip
• Important distinguish between hip flexors for injury/rehab/treatment

Question 2

Quad Strain

Answer 2

E: sudden stretch, or forceful flexion of hip and knee (overstretching)
MOI: sudden over-stretch or strong contraction

S/S: pain, swelling, ecchymosis (few days later), spasms, decreased ROM and strength of extensors

M: PIER, protect, NSAID, Neoprene sleeve

Question 3

Quad Strain Grade Management

Answer 3

Grade 1: Neoprene sleeve/tensor wraps

Grade 2: Rice (3-5 days), gradual isometric and pain free ROM exercises. Limited passive stretching until later phases

Grade 3: crutches (7-14 days), restore norm gait, compression for support, 12 weeks until full activity

Question 4

Hamstring Muscle Strain

Answer 4

E: most common thigh injury.
MOI: over-stretch of muscle in hip flex or sudden explosive contr.

S/S: pain, swelling, ecchymosis, spasms, and disability

M: PIER, protect, NSAIDS + concentrate on flexibility, modalities

Question 5

Hamstring Muscle Strain Grade Management

Answer 5

Grade 1: restore complete function before return

Grade 2: treated conservatively. Gradual stretching + strength in later stages, Isotonic leg curl (when Pain free), 1 month - 1 year, greater scarring = greater recurrence of injury

Question 6

Trochanteric Bursitis

Answer 6

E: inflam at gluteus medium I or where the IT band passes over the trochanter

S/S: compl. of lat hip pain (may radiate down), tender to palp. over lateral greater troch, IT and TFL test should be preformed

M: RICE, NAIDs, Analgesics, ROM and PRE directed to hip abductors + extern Rotators, Look at biomechanics and Q-angles. Runners avoid incline surfaces

Question 7

Hip Dislocation

Answer 7

E: rare is sport, traumatic force directed along long axis of the femur

S/S: Flexed, adducted and internally rotated hip. Palp reveal displaced fem head posteriorly, Serious pathology

M: Immediate medical care, contratures may further complicate reduction, 2 weeks immobilized and crutch for at least 1 month

Question 8

Hip Pointer (contusions)

Answer 8

E: contusion of illiac crest, due to direct blow, aggravated by almost all torso motion

S/S: pain, spasm, and transitory paralysis of soft tissue structures, decrease rotation of the trunk + thigh/hip flex

M: RICE (48 hours), Bed rest (1-2 days) refer to x-rays, Ice massage, ultrasound, occasionally steroid injection, 1-3 weeks