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?