Ephe 344 Hip, Groin & Pelvis

Femur - head with fovea capitis and neck, greater trochanter.

Hips - Ilium, ishcium, pubis.

Ligaments between both: iliofemoral, pubofemoral, ischiofemoral.

Muscles: Glute max, hanstrings, iliopsoas(usually too tight), rectus femorus (crosses 2 joints)

Piriformis - sciatic nerve exits underneath and can bind on the nerve.

Nerves: Sciatic (Posterior thigh), femoral (anterior thigh), oburator (adductors)

Veins/arteries: External iliac a., femoral a., great sapenous vein, femoral vein.

3 compartments - 1 anterior 2 posterior.

- Quads insert via common tendon above patella

- rectus femoris only quad that crosses the hip and knee

- Hamstrings cross knee joint posteriorly except short head of biceps crosses the hip.

Pelvis has 3 planes of mvmt

Hip is true ball and socket / stable

Hip moves in all 3 planes eg in gait. Large forces occur here.

Muscles most commonly injured in this region.

Many attachments here = hard to distinguish problem.

protective equipment - thigh pads, girdles, cups, braces, sleeves.

Physical conditioning - strength, endurance, flexibility.

Shoes - cushion forces.

Acute:

Contusions, myositis ossificans, strains (quads, hams, glutes, groin, hip flexor), sprains (hip), fractures (femoral), hip dislocations

Chronic/overuse: Trochanteric bursitis, femoral stress fracture.

E: Blunt trauma, muscular compression, extent of force and thigh relaxation = determinants.

S&S: Swelling, pain, bleeding, temp loss of function, weakness. Graded 1-4, superficial to deep.

M: RICE, knee flexion, crutches, therapy for pain. ROM and stretching, protect RTP, no massage or heat initially.

1: Little/no pain, mild hemorrhaging, no swelling, milk pt. tenderness, no disability.

2: Mild pain, swelling, (moderate) hemorrhaging, pt. tenderness, disability (less than 90 degree knee flex), limping.

3: Moderate pain, swelling, disability (greater than 45 but less than 90 degrees knee flex), limping.

4: Severe pain, swelling, disability (less than 45 degrees knee flex), muscle herniation (potentially), obv. limp unable to WB.

Hip pointer

E: Direct blow to iliac crest or abdominal musculature.

S&S: Pain, spasm, swelling, transitory paralysis of soft structures, decreased rotation of trunk or thigh/hip flex.

M: RICE for 48hrs, ice massage, protection w/ RTP, rule out fracture.

E: Form of ectopic bone following direct blow, repeated blunt trauma, improper care of thigh contusion.

S&S: Pain, weakness, swelling, pt tenderness, decreased ROM/function. X rays show deposits 2-6wks following.

M: Conservatively, physician referral. Compression shorts?

E: Inflammation glute med insertion wher ITB passes over trochanter = direct trauma.

S&S: Pt tenderness over lateral greater trochanter, lateral hip possibly radiating down leg. Pain straight down.

M:NSAIDS, RICE, ROM pf hip abductors and ext rotators. Look at Q angle, inclined surface avoidance.

1: Limited swelling, tightness. Near normal gait, mild pt tenderness/discomfort during palpitaiton. Soreness during mvmt, <20% fibers torn.

2: Pain and swelling w/ palpitation, palpable divot maybe, pain w/ resisted muscle testing, limping, muscle spasm, <70% fibers torn.

3: Rupturing tendinous or muscular tissue. Major hemorrhage and edema, major disability and loss of function, pain and palapble defect or mass. >70% fibers torn.

E: Sudden stretch, violent forceful contraction of hip and knee into flexion.

S&S: Pain, spasm, swelling, delayed bruising, loss of function, loss of ROM and strength or extensors.

M: RICE, crutches, wrap, later use of sleeve, slow ROM progressions, stretching, isometrics, 12wks RTP.

E: Sudden overstretch into hyperextension.

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

M: RICE, crutches, hip spica wrap.

E: Overlfexing hip, sudden explosive contraction/ acceletation. Fatigue, posture, leg lenght imbalances.

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

M: RICE, crutches, wrap, conservative treatment w/ gradual ROM/strengthening.

E: Overstretch into abduction, ER and hip extension.

S&S sudden twinge or tearing pain, swelling, delayed bruising, decreased ROM and strength.

M: RICE, rest is key, spica hip wrap.

E: Violent twisting with or without impact, forceful contraction, or trunk forced over planted foot in opposite direction.

S&S: Hip pain, increases with rotational movement.

M: xrays, RICE, crutches, delay ROM/Strengthening till pain free.

E: Traumatic force along long axis of femur (posterior dislocation w/hip flexed &knee flexed.)

S&S: flexed adducted internally rotated hip.

Deformity, pain, muscular spasm, neurological issues, possible fracture. Will look longer than the other leg!

M: 911, immediate care as neurovascular supply may be damaged. 2 wks immobilization and crutch for 1 month.

E: Lots of force, fall from height, direct blow. MVA?

S&S: pain, swelling, deformity (shorter), muscle guarding, hip adducted and externally rotated.

M: 911 call, treat for shock, nerovascular supply checks, vitals, splint, analgesics and ice, surgery and immobilization. Treat as life threatening as femoral artery winds around.

E: Overuse (10-25% all stress fractures), excessive downhill running/jumping.

S&S: Persistent pain in thigh/groin, antalgic gait, may be positive trendelenburg sign. Xray.

M: Vary on location. Lateral to femoral neck = complicated, others = better.

E: Repetitive stress on pubic symphesis, distance, runners, football, wrestling

S&S: Chronic pain and inflammation of groin, pint tenderness, pain w/ running, sit ups, squats. Acute case may be result of bike.

M: Rest, NSAIDS, gradual return to activity,

Good physical conditioning, CV fitness, edurance, strength.

Flexibility

Neuromuscular cotnrol/proprioception

Joint mobilization

Closed kinetic chain exercises.