Thigh, Hip, Groin, Pelvis

Question 1

where does the quad insert?

Answer 1

in a common tendon to the proximal patella

Question 2

which is the only quad muscle to cross the hip?

Answer 2

rectus femoris

Question 3

hamstrings cross the knee joint anteriorly or posteriorly?

do they all cross the hip?

Answer 3

posteriorly

all but the short head of the biceps

Question 4

bi-articulate (two joint) muscles produce forces depending upon what?

Answer 4

the position of the knee and the hip

*most of the muscles that cross at the hip also cross at the knee, hence, bi-articulate.

Question 5

Hip flexor strains impact what?

Answer 5

the position of the knee

Question 6

where are muscles most commonly injured?

Answer 6

the hip and pelvis

injuries are disabling and difficult to distinguish because there are lots of muscles that attach to this region

Question 7

How do we do an assessment of the hip?
History
Observation
Assessment

Answer 7

History= any neural pain? is it shooting? heading down? the farther away from the back we get the more concerned we are..as it localizes we are stoked

Observation= Gait (running/walk)

Assessment = flex/ext, abd/add, internal/external rotation

Question 8

Who is more likely to have a disc herniate?

Answer 8

Young people because there is more goo in their discs

Question 9

How do we do injury prevention for this body area?

Answer 9

Protective equipment: thigh pads, girdles, cups, praces,

Shoes- cushoning

Physical conditioning: muscular strength, balance, flexibility!!!!!!! endurance

Question 10

What are the potential acute injuries? (6)

Answer 10

Contusions 
Myositis ossificans (when you don't treat contusions properly)
Strains (quad, ham, add, hip flex)
Sprains (RARE-hip)
Fractures (femor
hip disolcation

Question 11

What are the potential chronic/overuse injuries?

Answer 11

Femoral stress fracture

Question 12

Quad contusions:
ET
SS
M

Answer 12

happens when esposed to blunt trauma causing muscular compression (tissue tears)
the extent of force and amt of thigh relaxation determines damage done

localized pain
bleding
swelling 
temprary loss of f(n)- weakness in extending or flexing knee
graded 1-4 superficial or deep 

RICE in knee flexion (72 hours, decrease chance of myositis ossificans), protect w crutches and NSAIDs
ROM and stretching
Protect with RTP (padding w tape job)
No massage or heat with acute onset—- only during rehab

Question 13

What is a grade 1 contusion?

Answer 13

mild hemorrhaging, little to no pain, no swell, mild pt tenderness, no ROM probs

wrap and put back in

Question 14

what is a grade 2 contusion?

Answer 14

mild pain, mild swell, mild to mod hemorrhaging, mild pt t, mild diability (>90 knee flexion), limping

no more play

Question 15

what is a grade 3 contusion

Answer 15

moderate pain, moderate swelling, moderately disabled (> 45 but <90 degrees of knee flexion)
obvious limbing

no more play

Question 16

What is a grade 4 contusion?

Answer 16

Severe pain, severe swelling, severe disability (<45 degrees of knee flexion)
POTENTIAL MUSCLE HERNIATION
obvious limb/ cannot weight bear

Question 17

Myositis Ossificans
et
ss
man

Answer 17

formation of ectopic bone following direct blow, repeated blunt trauma,
or improper care of thigh contusion

pain, weakness, swelling, point tenderness, decreased ROM and function
X ray will show deposits 2-6 weeks following

Manage conservatively (regain ROM)
Physician referral 
make them wear compression shorts

Question 18

Hip Pointer Contusion
et
ss
man

Answer 18

direct blow to iliac crest

pain, spasm, swelling, transitory paralysis of soft structures
decreased rotation of truck, OR decreased thigh/hip flexion
the obliques and the glut med insert here therefore it’s super debilitating

RICE 48hrs, ice massage, protect for RTP
physician referral to rule out fracture

Question 19

What is a first degree strain?

Answer 19

limited swelling and tightness
near normal gait
mild pt tenderness and discomfort during palpation
soreness during movement 
<20% of fibers are torn

Question 20

A second degree strain?

Answer 20

pain and swelling noted on palpation 
may note palpable divot 
pain with resisted muscle testing 
limping 
muscle spasm 
<70% of fibers torn

Question 21

A third degree strain?

Answer 21

Ruturing tendinous or muscular tissue
major hemorrhage and edema 
major disability and loss of function 
pain and palpable defect or mass
>70% of fibers torn

Question 22

Quadriceps Strain
et
ss
man

Answer 22

Sudden stretch or violent forceful contraction of the hip and knee into flexion or knee flexion with hip extension

SHARP: pain, spasm, swelling and delayed bruising, loss of function, decreased ROM and strength of extensors

RICE, crutches and wrap, later use of sleeve,
Progress to pain free ROM, isometrics (bc muscles don’t change length) and stretching
May require 12 wks RTP

Question 23

Hip flexor strain
et
ss
man

Answer 23

Sudden overstretch into hyerextension (can be from rec fem or soas)

Pain, swelling, delayed bruising, disability: decreased ROM and extensor strength.

RICE, crutches, hip wrap

Question 24

Hamstring Strain
et
ss
man

Answer 24

most common most debilitating

Eccentric load in hip flexion and knee extension
sudden explosive contraction or direction change or accel/decel
other factors include: fature, posture, leg length discrep, imbalances, hamstring dominance (no butt), muscle tighness

Pain, swelling, delayed bruising, spasm, loss of range and fn,

RICE, crutch and wrap
conservitive treatment with gradual ROM and strengthening

Question 25

Adductor strain
ET
SS
Man

Answer 25

Overstretch into abduction; abduction, external rotation and hip extension
running, jumping or twisting w external rotation

sudden twinge or tearing, pain, swelling, delayed bruising, decrease rom and strength

RICE, REST, hip wrap

Question 26

Hip Dislocation
ET
SS
Man

Answer 26

Rarely happens in sport (car accidents) & is more likely to happen in younger populations
there is posterior dislocation when traumatic force is applied along the long axis of the femur (sitting down)

Flexed, adducted and internally roated thigh
deformity (looks longer), pain, spasm, neuro problems, blood supply problems

call 911, immobilize and crutch use

Question 27

Legg-Calve-Perthes Disease

Slipped Capital Femoral Epiphysis

Answer 27

LCP: ages 4-10, boys>girls, disrupts circulation to femoral head causing necrosis
SCFE: ages 10-17, boys>girls, nobody knows why it starts, often those who are tall and thin or obese …the head of the femur is shifted

groin pain that won’t stop, limitied range and limp
LCP may refer into the abdomen or knee

Question 28

Femoral Fracture
et
ss
man

Answer 28

significant trauma, fall from height, MVA, direct blow, avascular necrosis

Pain, swelling, deformity (looks shorter), muscle guarding, hip slight and adduction and external rotation

911 HOES DON’T MOVE DIS LEGGGGGGGGGGGG

Question 29

Femoral Stress Fractures
ET
SS
Man

Answer 29

overuse
endurance athletes
excessive downhill running or jumping
female athlete triad — loss of glut med when they stand one one leg they cannot keep their hips level

persistant pain in thigh/groin; limp that increases during activity
a lot of muscle wasting and night pain

Prognosis will vary depending on location

Question 30

Osteitis Pubis
et
ss
man

Answer 30

Repetitive stress on pubic symphysis—seen in distance runners, soccer, football and wrestling

pain in groin and pubic symphysis; point tender, sit ups and swuats
acute case may be the result of a bicycle seat

rest, nsaids, gradual RTP