Kine Ch 14
Iliopsoas, Trochanteric, Gluteus medius, Ischiogluteal
4 bursae in the hip
Myositis ossificans
A condition that may occur after a contusion to quads, involving abnormal ossification of bone deposition within the muscle tissue is called..
Piriformis syndrome
A neuromuscular disorder that occurs when the sciatic n. is compressed or otherwise irritated by the piriformis muscle causing symptoms into the buttocks and along the path of the sciatic nerve descending down the lower thigh and into the leg.
Femoral triangle
Active infections or swelling in the LE will cause the lymph nodes to enlarge and become painful.
Osteitis pubis
An inflammation of the pubic symphysis and surrounding muscle insertions
Femoral hernias
Appear just below the groin crease and are usually the result of pregnancy and childbirth.
Sacroiliac joint
Articulation between the sacrum and the ilium
Ectopic bone formation
Bone formation occurring in an abnormal place
Apophysis
Bony outgrowth in which major muscles make their attachments
Pelvis
Bony ring formed by the two innominate bones, the sacrum and the coccyx
Quad Contusions
Bruised quadriceps muscle group.
Osteitis pubis
Chronic inflammatory condition caused by repetitive stress on the pubic symphysis and adjacent bony structures by the pull of the muscles in the area
Osteitis pubis
Clinical Presentation - Chronic pain and inflammation of groin. - Point tenderness on pubic tubercle. - Pain with running, sit-ups and squats.
Slipped Capital Femoral Epiphysis
Clinical Presentation - Difficulty walking, walking with a limp, knee and hip pain, hip stiffness, outward-turning leg, restricted hip movements.
Femoral stress fractures
Clinical Presentation - Pain occurs weeks after increasing workout intensity. - Persistent pain in thigh, groin, especially after activity. - Referred pain to knee. - X-ray or bone scan will reveal fracture. - Commonly seen in femoral neck
Piriformis syndrome
Clinical Presentation - Pain, numbness and tingling in butt, may extend below knee and into foot. - Pain may increase following periods of sitting, climbing stairs, walking or running.
Iliac crest contusion/hip pointer
Clinical Presentation - Pain, spasm, and transitory paralysis of soft structures. - Decreased rotation of trunk or thigh/hip flexion due to pain.
Sprains of hip joint
Clinical Presentation - Signs of acute injury and inability to circumduct hip. - Pain in hip region, with hip rotation increasing pain.
Groin strain
Clinical Presentation - Sudden twinge or tearing during active movement. - Produce pain, weakness, and internal hemorrhaging. - S/S consistent with grades 1-3
Quad muscle strain
Clinical Presentation Peripheral tear causes fewer symptoms than deeper tear. Pain, point tenderness, spasm, LOF, and little-to significant discoloration. Complete tear may leave athlete with little discomfort but with disability and deformity.
Myositis Ossificans
Clinical Presentation Pt. may c/o a warm, tender, firm swelling in a muscle and decreased range of motion in the joint served by the muscle involved. Tissue tension, point tenderness. X-ray shows calcium deposit 2-6 wks post injury.
Hamstring muscle strains
Clinical Presentation Muscle belly or point of attachment pain Capillary hemorrhage, pain, LOF, and discoloration.
Quad Contusions
Clinical Presentation: Pain, transitory LOF, immediate bleeding of affected muscles. Early detection and avoidance of internal bleeding are vital- increases recovery rate and prevents muscle scarring.
Dislocated hip
Clinical representation Palpation reveals displaced femoral head, posteriorly.
Innominate bones
Composition of 3 bones that ossify and fuse together early in life; these 3 bones are the ilium, ischium, and pubis
Quad contusion
Compression of the muscle against the femur as a result of severe impact to the thigh area
Pubic symphysis
Connects the left and right pubic bones in the center.
Sacrococcygeal joint
Consists of the articulation of the sacrum apex to the coccyx with support from the sacrococcygeall. (anterior, posterior, lateral) and intercornual ligaments.
Hip pointer
Contusion to the iliac crest
Iliac crest contusion/hip pointer
Contusions (possible avulsion - glut medius) to the iliac crest, surrounding soft-tissue, or the greater trochanter of the femur
Avascular necrosis
Death of an area or tissue due to a lack of blood supply
Coxa vara
Decreased angle = genu valgum(knocked knee)
Acetabulum
Deep socket of the innominate bones that contains a fat pad and articulates with the head of the femur
Femoral stress fractures
Difficult to diagnose and have a high incidence of fracture nonunion, complete fractures, or avascular necrosis, which may result in an unrecoverable injury.
Myositis ossificans traumatica
Ectopic bone deposits in muscle that result from severe or repeated blows to the thigh
Dislocated hip
Etiology - Athlete is running and lands on the feet or flexed knees, striking the ground while the hip is flexed, adducted, and internally rotated. - Athlete landing in the splits, with the hip flexed, abducted, and externally rotated.
Legg Calve'-Perthes Disease (Coxa Plana)
Etiology - Avascular necrosis of the femoral head in child ages 4-10. - Articular cartilage becomes necrotic and flattens.
Femoral stress fractures
Etiology - Excessive WB activity such as running, sprinting, jumping or dancing. - Often follow a recent increase in activity or change in training conditions (such as surface, footwear or technique changes etc) and are particularly common in long distance runners. - Uncommon injury- tends to occur in endurance athletes. - Females > Males
Acute femoral fractures
Etiology - Generally involving shaft and requires great force. - Occurs in middle third due to structure and point of contact.
Hamstring muscle strains
Etiology - Inadequate flexibility of the hamstrings can result in injury. This may be related to the patient having no or a poor stretching routine. - Inadequate strength or endurance of the hamstrings with either a side-to-side weakness or an imbalance between the hamstrings and the knee extensors can lead to injury. - Muscle fatigue can lead to muscular incoordination of muscle contraction. - Insufficient warm-up time may be involved. - Poor running technique may play a role. - Return to activity before complete healing has occurred can lead to recurrence.
Dislocated hip
Etiology - Large-force trauma (eg, motor vehicle accidents, pedestrians struck by automobiles) are the most common causes of hip dislocations. - This type of injury is also associated with high-energy impact athletic events (eg., American football, rugby, water skiing, alpine skiing/snowboarding, gymnastics, running, basketball, race car driving, equestrian sports).
Slipped Capital Femoral Epiphysis
Etiology - May be growth hormone related - 25% of cases are seen in both hips. - Epiphysis slips from femoral head in backwards direction due to weakness in growth plate. - May occur during periods of elevated growth.
Groin strain
Etiology - One of the more difficult problems to diagnose. - Seen early season due to poor strength and flexibility. - Occurs from running , jumping, twisting with hip external rotation or severe stretch
Sprains of hip joint
Etiology - Result of violent twist due to forceful contact. - Force from opponent/object or trunk forced over planted foot in opposite direction.
Piriformis syndrome
Etiology - Shortening or muscle spasms due to trauma or overuse, which causes can compress or strangle the sciatic nerve beneath the muscle.
Myositis Ossificans
Etiology Formation of ectopic bone following repeated blunt trauma. When the quad muscles bleed, a cascade of cellular responses can occur, causing heterotopic bone formation
Quad muscle strain
Etiology Sudden stretch when athlete falls on bent knee or experiences sudden contraction. Associated with weakened or over constricted muscle.
Iliac crest contusion/hip pointer
Etiology Typically caused by a direct blow or fall.
Osteitis pubis
Etiology - Seen in distance runners. - Repetitive stress on pubic symphysis and adjacent muscles.
Quad Contusions
Etiology: Direct blow (football, basketball, soccer) Constantly exposed to low impact traumatic blows.
Pubic symphysis
Fibrocartilaginous disc; connects the 2 separate pubic bones anteriorly and is supported by the superior and arcuate pubic ligament
G2 Hamstring muscle strains
Grade of hamstring strain partial tear, identified by sharp snap or tear, moderate-severe pain, and LOF.
G3 Hamstring muscle strains
Grade of hamstring strain rupturing of tendinous or muscular tissue, involving major hemorrhage and disability, edema, loss of function, ecchymosis, palpable mass or gap.
G1 Hamstring muscle strains
Grade of hamstring strain soreness during movement and point tenderness.
G2 Quad muscle strain
Grade of muscle strain A sudden sharp pain when running, jumping or kicking. Unable to play on. Pain affects walking. The athlete may notice swelling or even mild bruising. Pain on feeling the area of the tear. Straightening the knee against resistance causes pain. Unable to fully bend the knee.
G3 Quad muscle strain
Grade of muscle strain Sudden, severe pain in the thigh. Unable to walk without the aid of crutches. Significant swelling appearing immediately. Bruising usually appears within 24 hours. A static contraction will be painful; might produce a bulge in the muscle. Expect to be out of competition for 6-12 wk.
G2 Quad Contusions
Grade of quad contusion Consists of a deeper bruise consisting of moderate pain, swelling and discoloration along the injury site. Knee AROM is limited. The patient will demonstrate an obvious limping gait, possibly favoring the involved leg.
G3 Quad Contusions
Grade of quad contusion Consists of deep intramuscular mass, possibly causing it to bulge outward. Symptoms include severe pain, LOF, and increased edema and ecchymosis. Knee AROM is severely limited.
G1 Quad Contusions
Grade of quad contusion Consists of superficial intramuscular bruising producing mild bleeding and swelling, little pain and mild tenderness along the injury site. Little or no loss of ROM
G1 Quad muscle strain
Grade of quad muscle strain "Twinge" in the thigh. General feeling of tightness in the thigh. Mild discomfort on walking. Probably no swelling. Trying to straighten the knee against resistance may be uncomfortable. An area of local spasm may be felt at the site of the suspected tear.
PIIS
Greater sciatic notch is located inferior to the
Myositis Ossificans
Has been reported in 9% to 20% of all cases of quad contusions.
Angle of Inclination
Head of the femur is angled approximately 125° and forms the...
Iliac crest contusion
Hip pointer
Legg Calve'-Perthes Disease (Coxa Plana)
In English- blood supply is temporarily interrupted to the ball part of the joint. That part of the bone then breaks more easily and heals poorly.
Coxa valga
Increased angle = genu varum(bow-legged)
Myositis Ossificans
Inflammation of muscle leading to bone formation
Sacrum and ilium
Interlocking and slightly movable and are supported by the SI ligaments.
Femoral triangle
Its anatomy is very important for operating on hernia patients
Capsule
Large and loose Completely surrounds the joint attaching to the labrum of the acetabular socket.
Anterior Dislocated hip
Leg flexed, abducted and externally rotated.
Posterior Dislocated hip
Leg flexed, adducted and internally rotated.
SI joint
Ligaments span from the sacrum to the ilium and include - Anterior SI ligament - Posterior SI ligament - Sacroiliac interosseous ligament
Capitis femoris ligament
Ligamentum teres; runs from the femoral fovea (hole in the head of the femur) to the transverse acetabular ligament, helping to attach the femur head to the acetabulum and assisting with blood supply to that region.
Pubofemoral
Limits hip abduction/extension
Ischiofemoral
Limits hip extension
Y-ligament or ligament of Bigelow
Limits hip hyperexetension
Femur
Major WB bone Longest, strongest in the body.
Dislocated hip
Management - Immediate medical care (blood and n. supply may be compromised). - Contractures may further complicate reduction. - 2 weeks immobilization and crutch use for at least one month.
Femoral stress fractures
Management - Initial treatment involves rest. - While most head with conservative management, fracture may result. - May require surgical repair - Conservative therapy for compression fractures (return to sport in eight to 14 weeks).3
Hamstring muscle strains
Management - RICE - Restrict activity until soreness has subsided. - Ballistic stretching and explosive sprinting should be avoided initially.
Osteitis pubis
Management - Rest, NSAID's and gradual return to activity.
Piriformis syndrome
Management - Stretching and massage. - NSAID's may be prescribed. - Cessation of aggravating activities will be prescribed. - Corticosteroid injection may also be suggested. - Surgery is sometimes an option as well.
Acute femoral fractures
Management - Treat for shock, verify neurovascular status, splint before moving, reduce following X-ray in the emergency department - Secure immediate emergency assistance and medical referral
Sprains of hip joint
Management - X-rays or MRI should be performed to rule out fracture. - RICE, NSAID's and analgesics. - Depending on severity, crutches may be required. - ROM and PRE are delayed until hip is pain free.
Quad Contusions
Management RICE and NSAID's Crutches for more severe cases. Isometric quadriceps contractions should begin as soon as tolerated. Heat, massage and ultrasound to prevent myositis ossificans, but can't be too aggressive Padding may be worn for additional protection upon return to play.
Quad muscle strain
Management Rest, ice and compression to control internal bleeding. Determine extent of injury early.
Myositis Ossificans
Management Treatment must be conservative. Oral medications are used to prevent calcium from being deposited in the bony matrix May require surgery if painful and restricts motion (post 1-yr - remove too early, may return). If condition is recurrent it may indicate problem with blood clotting
Iliac crest contusion/hip pointer
Management/Prevention - RICE for at least 48 hrs, NSAID's. - Bed rest 1-2 days in severe cases. - Referral must be made, X-ray. - Padding should be used upon return to minimize chance of added injury.
Groin strain
Management/Prevention - RICE, NSAID's and analgesics for 48-72 hours. - Determine exact muscle or muscles involved. - Rest is critical. - Restore normal ROM and muscle imbalances (hip adduction concentric and eccentric activities)- provide support with an elastic wrap. - Refer to physician if severe groin pain is experienced.
Femoral hernias
More common in women but can occur in men.
Femoral hernias
More prone than inguinal hernias to develop incarceration or strangulation as an early complication.
Inguinal hernias
Most common hernias
Ischium
Most inferior of the pelvic bones and has a large prominence called the ischial tuberosity.
Compression fractures
Occur on the underside of the femoral neck.
Tension fractures
Occur on the upper side of the bone and can cause more problems than fractures on the underside of the femoral neck.
Pubic symphysis
Only a small degree of movement occurs at this joint Limited mainly to compression and rotation
Quad muscle strain
Prevention Neoprene sleeve may provide some added support.
Iliolumbar ligament
Prevents displacement of the 5th vertebra
Hernia
Protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it.
Hamstring muscle strains
Return to play - Between 3 wks and 6 months. - Isometric strength testing and flexibility testing may be performed prior to returning to play to ensure that no subtle deficits are present that may lead to chronic injury. - Less than 5 wks are required before return to play for patients with (1) superficial muscle injury or (2) muscle injury that involves a small cross-section of muscle. - In patients whose injury was due to poor biomechanics, care should be taken to correct the underlying cause. The patient should be supervised during stretching and exercise in order to assess poor technique and correct it.
Femoral stress fractures
Risk Factors - Poor foot posture (especially flat feet or high arches) - Muscle weakness (particularly gluteals, quadriceps and core) - Poor balance - Poor flexibility (particularly quadriceps, hamstrings, adductors and calfs) - Joint stiffness (particularly ankle, knee, hip or lumbar spine) - Inappropriate footwear - Inadequate diet - Inappropriate or excessive training (particularly on hard or uneven surfaces). - Poor running technique - Menstrual disturbance in females
Femoral triangle
Significant because the femoral nerve, a (pulse), and vein are all located in this area.
Legg Calve'-Perthes Disease (Coxa Plana)
Signs and Symptoms - Pain or stiffness in the hip, groin, thigh or knee - Limited range of motion of the hip joint - Usually involves just one hip, but both hips are affected in some children.
Acute femoral fractures
Signs and Symptoms - Shock, pain, swelling, deformity - Must be aware of bone displacement and gross deformity. - Loss of function.
Slipped Capital Femoral Epiphysis
Slipped capital femoral epiphysis is a separation of the ball of the hip joint from the thigh bone (femur) at the upper growing end (growth plate) of the bone.
Ober's Test
Test for IT band
Thomas test
Test for hip contractures.
Straight Leg Raise
Test for hip extensor tightness. Also assesses low back or SI joint dysfunction.
Deep trochanteric
The ___________ bursa provides a cushion between the greater trochanter of the femur and the gluteus maximus
Displaced fractures
The bone cracks all the way through, and the two bones no longer line up correctly.
Slipped Capital Femoral Epiphysis
The goal of treatment, which requires surgery, is to prevent any additional slipping of the femoral head until the growth plate closes. If the head is allowed to slip farther, hip motion could be limited. Premature osteoarthritis could develop.
Ball and socket joint
The hip joint is a classic...
ASIS, PSIS
The ilium has two bony prominences-
maximal flexion
The immediate management for a quad contusion includes the application of cold and a compression wrap with the knee in...
Femoral triangle
The inguinal l. serves to contain soft tissues as they course anteriorly from the trunk to the lower extremity.
L5 and S1
The lumbosacral joint consists of the articulation between the... vertebrae and is supported by the iliolumbar l.
Legg Calve'-Perthes Disease (Coxa Plana)
The name given to idiopathic osteonecrosis of the capital femoral epiphysis of the femoral head.
Femoral stress fractures
They are, however, extremely important because they are difficult to diagnose and have a high incidence of fracture nonunion, complete fractures, or avascular necrosis, which may result in an unrecoverable injury.
True
True or False: If a coach suspects that an individual has bursitis, the coach should permit the individual to continue activity, but reduce the amount of activity by 50%.
False
True or False: Regardless if the severity of a hamstring strain, the individual should automatically be put on crutches for at least 1 week
True
True or False: The gluteus medius is the major abductor at the hip
Femoral neck
Weakest point in the femur
Sacrum
Wedge-shaped "bone" composed of 5 fused vertebrae
Iliopsoas
What is a major hip flexor muscle?
Iliofemoral ligament
What is the main ligament that limits hip hyperextension?
Ilium, ischium, pubis
Which 3 bones is the pelvis consisted of?