Prevent & Treat Chapter 14

Grade III quadriceps strain

- extreme pain - ambulation not possible - defect in the muscle may be visible -resisted knee extension not possible, ROM is severely limited

Iliopsoas bursitis

-the largest bursa in the body -pain medial and anterior to joint, cannot by easily palpated -increase pain with passive hip rotation, resisted hip flexion, abduction, and external rotio

Grade I hamstring injury

-tightness and tension -pain with passive stretching

Grade III Quadricep contusion

-unable to bear weight or fully flex the knee

Hip sprain and dislocation are from

-violent twisting actions -with hip and knee flexed at 90 degrees, force through shaft of femur -rare because of multitude of movements allowed by the ball-and-socket joint

S & S of myositis ossification

-warm, firm, swollen thigh, 2-4cm larger -palpable, painful mass may limit passive knee flexion to 20-30 degrees -management: standard acute, physician referral

Quadriceps contusion

-within 24 hrs progressive bleeding and swelling occur -common site: anterolateral thigh -develops over a 24 hr period

Hip pointer (contusion)

Direct blow to the iliac crest (hip bone)

Femoral Triangle

Inguinal ligament- superior Sartorius- lateral Adductor longus- medial

Hip joint transverse plane

Medial and lateral rotation of femur

Hamstrings

- most frequent strained muscle in the body -typically caused by a rapid contraction of the muscle during a ballistic action -increase risk of injury by poor flexibility, poor posture, muscle imbalance, and improper warm-up

Management for a femoral fracture

-Activate EMS -Assess distal vascular integrity -Monitor and treat for shock -Defer immobilization until emergency -medical personnel arrive (traction splint will typically be applied) -NPO—possible surgical intervention

Management for a femoral shaft fracture

-Activate emergency plan, including summoning of EMS -Do not attempt to immobilize -Assess and treat for shock as necessary

S & S for a femoral fracture

-Previous history of femoral stress fracture ↑ risk of complete fracture -Extreme pain and inability/unwillingness to move involved side -Shock Neck: Individual supine, lower extremity in external rotation and abduction; appears shortened compared with other side Shaft: Limb appears shortened; thigh appears externally rotated

Sacral and Coccygeal fractures

-Rare in sports -Direct blow to area due to fall on buttock -S&S: extremely painful; unable to sit -Management: immediate referral to a physician

S & S for a femoral shaft fracture

-Severe pain and a total loss of functions -Swelling at fracture site -Present with the thigh externally rotated -Shortened limb deformity

Risk factors for a stress fracture to the hip

-Sudden increase in training (mileage, intensity, or frequency) -Change in running surface or terrain -Improper footwear -Biomechanical abnormalities -Nutritional and hormonal factors (anorexia, amenorrhea, osteopenia)

S & S of an adductor strain

-an initial "twinge" or "pull" of the groin muscles and is unable to walk because of the intense, sharp pain -as the condition worsens, increased pain, stiffness, and weakness in hip adduction and flexion

S & S of a hip pointer injury

-any trunk movement is painful (coughing, laughing, breathing) -immediate pain, discoloration, spasm, loss of function, tenderness -unable to rotate trunk or laterally flex the trunk toward injured side -severe injury- unable to walk or bear weight

Predisposing factors of a strain

-beginning of the season: too much too soon -fatigue -history of strains: reinjury common -restricted flexibility of involved muscle group

S & & of a Greater Trochanteric Brusitis

-burning or aching over posterior to greater trochanter -Aggravated with hip abduction and against resistance & hip flexion and extension on weight bearing *most common in female runners bc of the widened pelvis and larger Q angle

Snapping hip syndrome

-can result from chronic bursitis

Bursitis management

-caused by competitive stress -do not permit to continue activity until seen by a physician -apply cold to decrease pain and inflammation

S & S for a stress fracture to the hip

-diffuse or localized aching pain in anterior groin or thigh during weight-bearing activity, relieved with rest -night pain -antalgic gait may be present -inability to stand on involved leg

Management of Legg-Calve-Perthes disease

-do not permit to continue activity until seen by a physician

S & S of Legg-Calve-Perthes disease

-gradual onset of limp and mild hip or knee pain of several months in duration -pain is generally activity related -decrease in range of motion in hip abduction, extension, and external rotation due to spasm in hip flexors and adductors

Grade I Quadricep contusion

-mild pain and swelling -able to walk without a limp -passive flexion beyond 90 degrees is painful

S & S of a hip sprain or dislocation

-mild/moderate: pain with internal rotation -severe: intense pain; inability to move

Management of hip sprains and dislocations

-mild/moderate: standard of care; physician referral -sever: activate EMS, immobilize in position found, do not move, monitor and treat for shock

Grade I quadriceps strain

-normal gait, but tightness in the anterior thigh -pain with passive knee flexion beyond 90 degrees

S & S for a slipped capital femoral epiphysis

-often undetected other than diffuse knee pain -later stages: are more comfortable holding leg in slight flexion, unable to touch abdomen with the thigh bc the hip externally rotates with flexion, unable to rotate the femur internally or stand on one leg

Ischial bursitis

-pain aggravated by prolonged sitting and uphill running -point tenderness directly over ischial tuberosity -increased pain with passive and resisted hip extension

Adductors strain

-result from a quick change in direction, explosion, or acceleration -strength imbalance

S & S of an adductor strain

-running straight ahead or backward may be tolerable, but any side-to-side movement leads to more discomfort and pain -pain with passive stretching with the hip extended, abducted, externally rotated -pain with resisted hip adduction

Grade III hamstring injury

-sharp pain may occur during midstride -limps, unable to do heel-strike or fully extend the knee -pain and muscle weakness with active knee flexion

Grade II quadriceps strain

-snapping or tearing sensation, followed by immediate pain and loss of function -knee help in extension: protection -pain with passive knee flexion: pain and weakness with knee extension -experienced during an explosive jumping, kicking or running motion

S & S of snapping hip syndrome

-snapping sensation heard or felt during hip motion, especially with lateral rotation and flexion while balancing on one leg -affects the iliopsoas bursa: snapping in medial groin -prevalent in dancers, runners, cheerleaders

Management of a hip pointer injury

-standard acute care, rest, and protect with hard shell pad -rest during 2/3 days after injury -crutches needed if walking is painful

Management of a quadriceps contusion

-standard acute; with knee in maximum flexion (limits intramuscular bleeding and spasm) -hard pad to return to activity -physician referral if S & S are longer than 48 hours

S & S of a hip fracture (avulsion fracture)

-sudden, acute, localized pain which may radiate down muscle -swelling and discoloration -palpable gap between tendon attachment and bone -increase pain with AROM, PROM, RROM of involved muscle

Grade II hamstring injury

-tearing sensation or feeling a "pop" leading to immediate pain and weakness in knee flexion

The management for a suspected hip dislocation includes?

Activation of EMS and to fit the individual with crutches for transport

Adductors

Active during the swing phase of gait, bringing the foot beneath the body's center of gravity for placement during the support phase *Contribute to flexion and internal rotation at the hip

Hip adductors

Adductor longus Adductor brevis Adductor magnus

Management of a slipped capital femoral epiphysis

Do not permit continued activity until seen by a physician

Management of a stress fracture to the hip

Do not permit to continue activity until seen by a physician

Hip fractures (avulsion fracture)

Due to rapid, sudden acceleration and deceleration -apophyseal sites do not unite with the bone until ages 18-25

Femoral Triangle contents

Femoral nerve Femoral artery Femoral vein

Which of the following is considered a medical emergency that require activation of the emergency plan, including summoning of EMS?

Femoral shaft

Management of a hip fracture (avulsion fracture)

Fit with crutches, immediate physician referral

When the head of the femur displaces in a posterior superior direction during a hip dislocation, the leg typically rests in what position?

Flexed and internally rotated

Physical conditioning for injury prevention?

Flexibility and strength

Hip joint sagittal plane

Flexion and extension

Sacrococcygeal joint

Fused line symphysis united by a fibrocartilaginous disc *freely movable and synovial

The major hip abductor muscle is?

Gluteus medius

Hip abductors

Gluteus medius Gluteus minimus *Active in stabilizing pelvis during single-leg support and during support phase of walking and running

Medial rotators (internal rotation)

Gluteus minimus Tensor fascia latae Semitendinosus Semimembranosus Gluteus medius Adductor muscles *relatively weak

The rectus femoris is responsible for what motion?

Hip flexion and knee extension

Protective equipment for injury prevention?

Hip joint well protected (iliac and pelvis) Thigh

Hip Flexors

Iliopsoas Pectineus rectus femoris sartorius Tensor fascia latae

Pubic symphysis

Interpubic disc located between the two joint surfaces *cartilaginous joint

Pubofemoral ligament

Limits abduction and hyperextension

Ischiofemoral ligament

Limits extension

Iliofemoral ligament

Limits hyperextension

Femur

Longest, largest, and strongest bone in the body *femoral neck is the weakest part because it is smaller in diameter

A condition that may occur after a contusion to the quadriceps muscle group, involving abnormal ossification of bone deposition within the muscle tissue is called?

Myositis ossificans

Lateral rotators (external rotation)

Piriformis Gemellus superior Gemellus inferior Obturator internus Obturator externus Quadratus femoris *lateral rotation of femur of swinging leg accommodates lateral rotation of pelvis during stride

Pelvis

Protects against organs, transmits loads between the trunk and lower extremities, and provides a site for muscle attachments

Stress Fractures to the hip

Pubis, femoral neck, and proximal 1/3 of femur -seen in individuals who do extensive jogging or aerobic dance activities to the point of muscle fatigue

Pain with passive knee flexion and pain and weakness with active knee extensions are indicative of a strain involving the?

Quadriceps

Two joint muscles

Rectus femoris- active during hip flexion and knee extension Sartorius- active during hip flexion and knee extension

Myositis ossificans

Result of multiple impacts which cause damage to the sheath that surrounds a bone (periostium) -evidence of calcification on a radiograph visible after 3-4 weeks -6-7 weeks, the mass generally stops growing ad resorption occurs

Pelvis is composed of 4 muscles?

Sacrum Coccyx Innominate bones (ilium, ischium, pubis)

If an adolescent boy is unable to perform internal rotation at the hip or stand on one leg without severe pain, which of the following conditions should be suspected?

Slipped capital femoral epiphysis

Management of a grade II/III strain

Standard acute and a physician referral is needed

Management of a grade I strain

Standard acute and if symptoms persist more than 2-3 days a physician referral is needed

Quadriceps strains

location: typically to the rectus femoris -less common than hamstring strains

In a femoral shaft fracture, the thigh appears:

shortened and externally rotated

Management of snapping hip syndrome

- do not permit to continue activity until seen by a physician -apply cold to decrease pain and inflammation

Hip joint

-Head of femur and acetabulum of pelvis -Ball and socket joint -Very stable

Grade II Quadricep contusion

-can flex the knee between 45-90 degrees -walks with a noticeable limp

Hip joint frontal plane

Abduction and adduction

Femoral shaft fracture

Can be very serious because of potential damage to neurovascular structures from bony fragments -tremendous impact forces -direct compressive forces

Legg-Calve-Perthes disease

Caused by diminished blood supply to the capital region of the femur and leads to a progressive necrosis of the bone and marrow of the epiphysis of the femur head (avascular necrosis of proximal femoral epiphysis) -seen especially in males ages 3-8

Slipped capital femoral epiphysis

Commonly seen in an obese adolescent with underdeveloped sexual characteristics (ages 12-15) -the femoral head slips at the epiphyseal plate and displaces inferiorly and posteriorly relative to the femoral neck

SI joint

Critical link between the two pelvic bones and strong ligamentous support *works with the pubic symphysis

Hip Extensors

Gluteus maximus Hamstrings (biceps femoris, semitendinosus, semimembranosus)

The management for a quadriceps contusion includes ice application and a compressive wrap with?

The knee in a maximal flexion

Women runners who have a wider pelvis and larger Q angle are at a greater risk of developing what?

Trochanteric bursitis