Week 8: Injuries of the Hip, Thigh and Groin Flashcards
Plica
-A piece of fibrous tissue extending from the joint capsule, that is supposed to reabsorb during growth & development
-These bands of tissues can sometimes be left over & get in the way of the joint - mimicking a meniscus injury
Key Structures of the Hip and Pelvis
-Iliac Crest
-Anterior Superior Iliac Spine (ASIS) *Origin of sartorius
-Anterior Inferior Iliac Spine (AIIS) *Origin of rectus femoris
-Posterior Superior Iliac Spine (PSIS)
-Ischial Tuberosity *Origin of hamstrings
-Pubic Symphysis
-Hip Joint and articular cartilag
Hip Flexors (6)
- Psoas
- Iliacus
- Sartorius (part of pes anserine group)
- Rectus Femoris
- Pectineus
- Tensor Fascia Latae (assists)
Quadriceps (4)
- Rectus femoris
-Origin AIIS (NB palpation point)
-Only quad muscle that also does hip flexion - Vastus lateralis
- Vastus intermedius
- Vasus medialis
*Common insertion via quad tendon into patella
Hamstrings
Medial hamstrings
1. Semimembranosus
2. Semitendinosus (part of pes anserine group)
Lateral hamstrings
3. Biceps femoris
Adductors
- Pectineus
- Adductor Longus
- Adductor Magnus
- Adductor Brevis
- Gracillis (part of pes anserine group)
Acetabular Labrum
-Fibrous cartilage
-Rims the acetabulum
-Deepens the socket
-Increases stability of joint
-Base of labrum that attaches to the bone has some capacity to heal from blood supply from bone; free edge limited blood supply so doesn’t heal well
Hip Pointer
-Contusion of iliac crest (periosteum has lots of sensory nerves!)
-MOI: blunt trauma to iliac crest
-S&S: pain (often severe) with trunk flexion, rotation, side bending or hip flexion, bruising & swelling over iliac crest, muscle spasm of surrounding muscles
-Other structures affected:
External Obliques and Tensor Fascia Latae (TFL)
-Athletes often report pain with forced exhalation, pain with bowel movements (all functions of external obliques)
Acute management:
-PIER (with pressure pad if tolerated – sometimes can’t tolerate NOT having one)
-Lymph drainage to settle spasm
-Donut pad with cover for RTP, possibly with hip flexor wrap if hip flexion affected
-What else needs to happen for safe RTP? *Full ROM, sport-specific movements (rotating, running/gait) and strength
Case study:
-RB gets tackled
-Down on field, keeps attempting to get up but can’t
-Holding left side, sharp burning pain in “top of hip”
Acetabular Labral Tears
-MOI: acute plant & twist or hyperabduction (splits); overuse degeneration
-S&S: Pain, clicking/catching in hip or groin, hip ROM, audible pop/sensation at time of injury (often none with overuse)
-“C” sign: common descriptor of pain *Anterior and into groin= true hip pain
-Special Test: Scouring Test
-Acute management: ice, rest, pain management
-Correct mechanics (stable base → core & hip stability)
-Proprioception
-Refer – surgery if conservative treatment to pain & mobility isn’t effective
Scouring Test
-Highly sensitive, but lacks specificity
-Good indicator of pathology in the joint itself
Tests for:
-Hip labrum tears
-Capsulitis – inflamm of capsule leading to scar tissue
-Osteochondral defects – bone & cartilage
-Acetabular defects
-Osteoarthritis
-Avascular necrosis – bone death from decreased blood supply
-Femoral acetabular impingement syndrome – irregular shape of one or both joint surfaces leading to labrum/cartilage tears
ITB Friction Syndrome
-MOI: ITB friction over lat femoral condyle 2° to biomech causes
-Overuse condition from friction over lateral femoral condyle
-Common in sports with continuous knee flex & ext like running or cycling
-Glute med weakness may be a contributing factor
-Camber of the road can contribute – why?
-Check type of footwear & wear patterns
-Biomech assessment
-Winter boots/walking in snow common factor (no support, slippery conditions, have to stabilize further up the chain)
-How can we prevent excessive traction on ITB: biomechanics, environment, flexibility
-How can we settle the inflammation: decrease strain from surrounding areas, PIER, lymph drainage (soft tissue work)
Thomas Test
Tests for length of quad (rectus femoris) IT band and patellar tendonitis
Negative Test: hamstrings touch the table, knee in approx. 80° of flexion, thigh in midline, foot straight forward (not rotated)
Positive test:
-Hip flexion: hip flexor tension (typically psoas)
-Hip flexion with knee extension: rectus femoris
-Abducted hip: tight iliotibial band (ITB)
-Rotated tibia: tight ITB
*Be sure to control pelvic tilt
Hip Flexor Tendonitis
-MOI: overuse, repetitive flexion
-Cyclists, runners, dancers, gymnasts
-S&S:
-Pain with active & resisted hip flexion
-Stretch pain with passive hip extension
-TOP affected tendon
-Acute management: ice, rest/altered activity, hip flexor wrap
Strains of the Hip and Thigh (Quads vs. Hamstrings vs. Adductors)
-Hip Flexors: MOI: Forceful hip flexion, leg caught in hip extension (or combo of both)
-Quads: MOI: Forceful quad contraction, hip extension with
knee flexion (or combo of both)
-Hamstrings: MOI: excessive hip flexion with extended knee, in sprinting - eccentric hams contraction in late stance phase
-Adductors: MOI: quick cutting (overstretch with forceful contraction), splits type motion (contact, slippery surface)
Classification of Sprains and Strains (RECALL)
Grade 1 or 1st degree: tissues stretch/some fibers disrupted
-For sprains, integrity of the joint maintained
-For strains, contractions are strong but painful
Grade 2 or 2nd degree: partial tear/many fibers disrupted
-For sprains, results some instability/laxity in the joint
-For strains, contractions are weak and very painful
Grade 3 or 3rd degree: complete tear
-For sprains, results in significant instability/laxity in the joint
-For strains, unable to contract and often pain-free (nerve fibers were torn too!)
