Week 12 - Thigh, Hip, Groin, Pelvis Flashcards
History?
Observation?
LLD (anatomical and functional
Postures
- knee/ feet
- iliac crest level
- PSIS level w/ ASIS - equal depressions
- Back positions (scoliosis, lordosis)
- Glute med strength (one leg stand - Trendelenburg test)
Palpation?
Find bony landmarks - Trochanters, ASIS, PSIS
- localize ligs/ tendon insertion
- SHARP
- msc guarding
- trigger points
Special Tests?
A/P/RROM
- check joint above and below
- Hip flex/ ext/abd/add/
- Back flex/ext/abd/add
Neuromsc involvement
- Dermatomes, myotomes
Thomas Test
- flexibility
Faber test
- figure 4
- Flex, Abd, ER
- + test = hip joint/ SI joint pathology
Straight leg raise
- tightness in hip extensors
+ if leg cant flex to 90
tests neural involvement (+ if pain in buttocks or down back of leg)
Functional tests/
Gait
Fulll squat
Balance/ proprioception
hopping
direction change
Avulsion #?
At place of Apophysis (bony protrudence)
Ischial tuberosity, AIIS (most common - rectus femoris attaches here), ASIS
Sudden acceleration or deccel
S&S = sudden pain and local tenderness, swelling
Tx
- xray, POLICE, NWB 1-2 months
- Need - radiograph for R2P
Hip Dislocation?
MOI
- Force along long axis of femur when knee is flexed
S&S
- flexed, abducted, IR, shortened
Tx
- 991 - scoop stretcher
- treat for shock
- Reduce
- 2 weeks immobilize
crutches for >1 month
functional recovery in 3 months
Quad msc strain?
MOI
- sudden stretch, Sudden contraction, forceful contraction of hip and knee flexed
S&S
- very disabling (especially RF)
- Pain, TOP, guarding, loss of function,
- Pain w/ AROM knee extension// flex - PROM knee flexion
- RF will have pain w/ AROM hip flex/ext, PROM hip ext
- Possible deformity if complete tear
Quad msc strain Grading?
Grade I: tightness of anterior thigh; near normal gait;
may be limited swelling; mild discomfort during palpation
* Grade II: Abnormal gait cycle; noticeable swelling; pain
on palpation; possible defect in muscle; strength deficit
(4/5)
* Grade III: Possibly unable to walk; pain with palpation;
may be unable to perform knee extension; isometric
contractions may produce defect or bulging in muscle
belly
Quad Strain Tx?
Immediate Tx:
* Grade I: Neoprene sleeve or tensor may
provide some added support
* Grade II: Compression for 3-5 days with
gradual increase in isometric exercises
and pain-free knee ROM exercises
* Limit passive stretching until later
phases
* Functional recovery in 14-21 days
* Grade III: Crutch use for 7-14 days;
restore normal gait; compression for
support; may require 12 weeks until
returning to full activity
Quad msc strain Prevention?
Prevention:
* Proper warm-up
* Quadriceps stretching and strengthening
* Agility and proprioception training
Hamy Strain?
Most common thigh injury (2-joint msc, knee flexion, hip extension, tight)
* MOI:
* Multiple theories of injury
* Hamstring and quad contract together
* Change in role from hip extender to knee flexor
* Fatigue, posture, leg length discrepancy, lack of flexibility,
strength imbalances (should be 60-70% of quad strength)
* SSx:
* Muscle belly or point of attachment pain
* Pain, loss of function, possible discoloration
* Pain with: AROM knee flexion, AROM/PROM knee extension,
AROM hip extension, AROM/PROM hip flexion
Hamy Strain Grading?
Grade I - soreness during movement,
stiffness, point tenderness
* Usually symptoms appear after
the athlete has cooled down post-
exercise
* Grade II - partial tear, severe pain,
loss of function (knee flexion),
possible defect on palpation
* Grade III - Rupturing of tendinous or
muscular tissue, major hemorrhage
and disability, edema, loss of
function, ecchymosis, palpable mass
or gap
Hamy strain Tx?
Immediate Tx:
* Grade I: Neoprene sleeve or tensor may provide some
added support
* Grade II: Compression for 3-5 days with gradual
increase in isometric exercises and pain-free knee ROM
exercises
* Limit passive stretching until later phases
* Grade III: Crutch use for 7-14 days; restore normal gait;
compression for support
* Recovery may require months to a full year
* Want full ROM, strength before RTP
Evidence-Based Rehab Example:
Hamy strain Rehab (Conventional vs. Lengthening Rehab)?
Methods Summary:
* 75 elite Swedish football players with acute hamstring injury
(verified with MRI)
* Mean age = 25 years, 92% male
* 37 completed rehab protocol emphasizing hamstrings lengthening
exercises
* 38 completed rehab protocol consisting of conventional exercises
* Outcome measures:
* Number of days to return to full-team training
* Re-injuries in following year
Conventional vs Lengthening Rehab?
Conventional = Contract and relax, stretching
Lengthening = Eccentric –> low reps. Time to R2P was shorter than conventional and had less chance of re-injury.
Hamstring Re-injury?
Occur in the same msc and location and usually very soon after R2P.
Get injured side to 90% strength before R2P
Hamy Strain Prevention`
Prevention:
* Hamstrings strengthening (goal is at least 60-70% of
quadriceps strength)
* Eccentric training
* Flexibility training
Hip Pointers MOI, S&S, Tx?
MOI:
* Contusion to iliac crest resulting in
pinching of overlying soft tissue
- SSx:
- Pain, guarding, reduced lumbar rotation,
hip flexion, TOP ASIS and iliac crest - Immediate Tx:
- POLICE
- Radiograph to rule out fracture
- Rest (1-3 weeks)
- Stretching (sub-acute)
Quad Contusion MOI and S&S?
MOI:
* Traumatic blunt blow
* Muscle compressed against
hard surface of femur
- SSx:
- Pain, temporary loss of
function (walking), immediate
effusion with palpable
swollen area, ecchymosis - Pain during active/passive
knee flexion, active knee
extension
Quad Contusion S&S for Grading?
SSx:
* Grade 1: mild
* Superficial, mild
hemorrhage, minimal pain,
no swelling, mild point
tenderness, normal ROM
- Grade 2: moderate
- Pain, swelling, <90 degrees
knee flexion, antalgic gait - Grade 3: severe
- Possible muscle herniation,
severe pain, swelling,
possible hematoma, antalgic
gait, knee flexion ~ 45
degrees
Quad Contusion Tx?
POLICE
* Tensor bandage to provide pressure
* Elevate and compress in as much pain-free flexion as possible (goal 120 degrees)
* Crutches if antalgic gait
* Isometric quadriceps exercises as tolerated
* ROM, strengthening within pain free
range
* Aspiration of hematoma or herniation repair (surgery) is possible
* Prevent myositis ossificans
Figure 21-4* Avoid another severe contusion
* Protective hard cover padding
* Avoid massage/heat (acute)**
Stress # MOI and S&S and Tx?
MOI:
* Stress fractures to inferior ramus of the pubis, femoral neck,
subtrochanteric area of femur can occur with distance
runners (women>men)*
- SSx:
- Groin pain, radiating ache into thigh, most painful at night
- asian/ Caucasian women
- Immediate Tx:
- Rest for 2 – 5 months
- WB guided by pain
- Swimming, biking to maintain cardiovascular endurance
- Prevention:
- Proper training progression
Femoral-acetabular Impingement (FAI)?
Motion-related disorder of the hip joint due to either cam and/or pincer
morphology
* Bony growth causes abnormal contact between hip and acetabulum
* Can lead to labral tears or osteoarthritis
* Most common diagnosis related to chronic groin pain leading to
surgical management
Femoral-acetabular Impingement S&S?
Pain in groin, but may radiate toward outside of leg
* Worst with hip rotation and flexion
* Can be dull ache at rest
* Stiffness
* Antalgic gait
Feels like a labral tear - Pinch
Not an acute injury
Usually in more active people in their 20s-30s
