Chapter 14 Hips

Bursae

-Iliopsoas -Deep trochanteric bursa -Gluteofemoral bursa -Ischial bursa

C. myositis ossifcans

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: A. exostosis B. myochondritis exostosis C. myositis ossificans D. osteochondritis

Hip pointer

MOI: direct blow to iliac crest S&S: any trunk movement is painful, immediate pain, discoloration, spasm, and loss of function, unable to rotate trunk or laterally flex the trunk toward the injured side, extreme tenderness, abdominal muscle spasms, unable to walk or bear weight for severe injuries Management: rest, protect with hard shell pad for return to activity; if severe pain over iliac crest refer to physician

Injury prevention

Physical conditioning (flexibility and strength), protective equipment, and shoe selection are all types of:

D. Biceps Femoris E. Semimembranosus F. Semitendinosus

Which of the following constitute the hamstrings? A. Iliopsoas B. Rectus femoris C. Sartorius D. Biceps femoris E. Semimembranosus F. Semitendinosus G. Gluteus maximus H. Gluteus medius

Legg-Calve-Perthes disease

-Avascular necrosis of proximal femoral epiphysis -Seen especially in males ages 3-8 -Osteochondrosis of femoral head S&S: gradual onset of limp and mild hip or knee pain of several months in duration, pain is generally activity related, decreased ROM in hip abduction, extension, and external rotation due to spasm in hip flexors and adductors Management: do not permit to continue activity until seen by a physician

Predisposing factors for strains

-Beginning of season- too much, too soon -fatigue -history of strains; reinjury common -restricted flexibility of involved muscle group

Hip Joint

-Head of femur and acetabulum of pelvis -Ball and socket joint -Very stable -Strong ligament support: Iliofemoral ligament limits hyperextention Pubofemoral ligament limits abduction and hyperextension Ischiofemoral ilgament limits extension

Pelvis

-protects the organs -transmits loads between trunk and lower extremities -provides site for muscle attachments -made up of fused bones (sacrum, coccyx, innominate bones: ilium, ischium, and pubis)

Stress fractures

-pubis, femoral neck, and proximal one-third of femur S&S: diffuse or localized aching pain in anterior groin or thigh during weight-bearing activity (relieved with rest), night pain, and antalgic gait may be present, increased pain on extremes of hip rotation, abduction lurch, inability to stand on involved leg Management: do not permit to continue activity until seen by a physician

Hip adductors

Adductor longus, adductor brevis, and adductor magnus

Avulsion fractures

Due to rapid, sudden acceleration and deceleration Apophyseal sites: -ASIS with displacement of sartorial -AIIS with rectus femurs displacement -Ischial tuberosity with hamstrings displacement -Lesser trochanter with iliopsoas displacement S&S: sudden, acute, localized pain that may radiate down the muscle, swelling and discoloration, palpable gap between tendon attachment and bone, increased pain with AROm, PROM, RROM of involved muscle Management: fit with crutches, immediate physician referral

Lateral rotators

External rotation -Piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, and quadratus femoris -Lateral rotation of femur of swinging leg accommodates lateral rotation of pelvis during stride

Sacrococcygeal joint

Fused line symphysis united by a fibrocartilaginous disc

Hip extensors

Gluteus maximus and hamstrings (biceps femoris, semitendinosus, semimembranosus)

Hip abductors

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

Frontal

Hip joint movement of abduction and adduction

Sagittal

Hip joint movement of flexion and extension

B. Slipped capital femoral epiphysis

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? A. Legg-calve-perthes B. slipped capital femoral epiphysis C. avulsion of the ASIS with the displacement of the sartorius D. stress fracture of the femoral shaft

A. shortened and externally rotated

In a femoral shaft fracture, the thigh appears: A. shortened and externally rotated B. shortened and internally rotated C. to be the same length, but externally rotated D. to be the same length, but internally rotated

Hamstring Strain

Initial swing-- flex knee; late swing-- eccentrically contract to decelerate knee extension and re-extend hip in prep for stance phase; overemphasis on stretching without strengthening; additional risk factors, strength imbalance S&S: grade 1 --> tightness and tension, pain with passive stretching; grade 2 --> tearing sensation or feeling a "pop" leading to immediate pain and weakness in knee flexion; grade 3 --> 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

Medial rotators

Internal rotation -Gluteus minimus -Tensor fascia latae, semitendinosus, semimembranosus, gluetus medius, and adductors

Quadriceps contusion

MOI: direct blow (common area is anterolateral thigh) S&S: pain may be extensive immediately after impact, Grade 1 = pain and swelling, able to walk without a limp, passive flexion beyond 90 degrees may be painful; resisted knee extension may cause less discomfort; Grade 2 = can flex the knee between 45 and 90 degrees and walk with a noticeable limp; Grade 3 = unable to bear weight or fully flex the knee Management: with knee in maximum flexion, hard shell pad for return to activity; if S&S persist longer than 48 hours, physician referral is needed

Bursitis

MOI: excessive friction or shear forces due to overuse Greater trochanteric- influence of Q angle S&S: burning or aching over or posterior to greater trochantor; aggravated with hip abduction against resistance and hip flexion and extension on weight bearing Management: cold to decrease pain and inflammation

Femoral shaft fracture

MOI: tremendous impact forces, direct compressive forces; potential for neurovascular damage S&S: severe pain and a total loss of functions, swelling at fracture site, present with the thigh externally rotated, shortened limb deformity Management: activate emergency plan, including summoning of EMS, do not attempt to immobilize, assess and treat for shock as necessary

Hip sprains and dislocations

MOI: violent twisting actions S&S: mild/moderate pain--> pain with internal rotation; Severe --> intense pain, inability to move hip Management: mild/moderate pain --> standard for acute, physician referral; severe --> activate EMS; immobilize in position found, do NOT move, monitor and treat for shock

Ischial bursitis

Pain aggravated by prolonged sitting and uphill running Point tenderness directly over ischial tuberosity; increased pain with passive and resisted hip extension

Iliopsoas bursitis

Pain medial and anterior to joint; cannot be easily palpated Increased pain with passive hip rotation, resisted hip flexion, abduction and external rotation

A. Quadriceps

Pain with passive knee flexion and pain and weakness with the active knee extensions are indicative of a strain involving the: A. quadriceps B. hamstrings C. iliopsoas D. adductors

Scral 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

Quadricep Strain

Rectus femoris S&S: grade 1 --> normally gait, but tightness in the anterior thigh, pain with passive knee flexion beyond 90 degrees; grade 2 --> snapping or tearing sensation, followed by immediate pain and loss of function, knee held in extension (protection), pain with passive knee flexion, and pain and weakness with knee extension; grade 3 --> extreme pain, ambulation not possible, defect in the muscle may be visible, resisted knee extension not possible; ROM is severely limited

Two Joint muscles

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

C. Flexion and extension

Sagittal plane movements at the hip include: A. Medial and lateral rotation B. Abduction and adduction C. Flexion and extension

Slipped capital femoral epiphysis

boys ages 12-15 -femoral head slips at epiphyseal plate and displaces inferiorly and posteriorly S&S: early S&S often undetected other than diffuse knee pain; later stages are ore comfortable holding the leg in slight flexion; Later stages: unable to touch the abdomen with the thigh because the hip externally rotates with flexion, and unable to rotate the femur internally or stand on one leg Management: do not permit to continue activity until seen by a physician

Myositis ossificans

develops secondary to single significant blow or repetitive blows to the same area; evident on radiograph 3 to 4 weeks after injury S&S: warm, firm, swollen thigh (2-4 cm larger), palpable painful mass may limit passive knee flexion to 20-30 degrees, active quadricep contractions and straight leg raises are difficult Management: standard; physician referral for worse

Adductor strain

quick changes of direction and explosive propulsion and acceleration, strength imbalance S&S: an initial "twinge" or "pull" of the groin muscles, and is unable to walk because of intense sharp pain; as the condition worsens, increased pain, stiffness, and weakness in hip adduction and flexion, 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 hip extended, abducted, and externally rotated, and pain with resisted hip adduction

Femur

-Longest, largest, and strongest bone in the body -Weakest at the neck

Femoral triangle

Borders: -inguinal ligament: superior -sartorius: lateral -adductor longus: medial Contains: -femoral nerve -femoral artery -femoral vein

SI Joint

Critical link between the two pelvic bones -strong ligamentous support

Hip joint

Has movement in 3 planes

Transverse

Hip joint movement of medial rotation and lateral rotation of the femur

Hip Flexors

Ilipsoas, pectineus, rectus femoris, sartorius, and tensor fascia latae

Pubic symphysis

Interpubic disc located between the two joint surfaces

D. Hip extension

The iliofemoral ligament prevents excessive: A. Hip abduction B. Hip flexion C. Hip adduction D. Hip extension

B. Gluteus medius

The major hip abductor is: A. Gluteus maximus B. Gluteus medius C. Gluteus minimus D. Psoas

B. the knee in maximal flexion

The management for a quadriceps contusion includes ice application and a compressive wrap with: A. the knee flexed at 90 degrees B. the knee in maximal flexion C. the knee in full extension

Hamstrings

Two joint; hip extension and knee flexion

Snapping hip syndrome

Can result from chronic bursitis S&S: snapping sensation heard or felt during hip motion, especially with lateral rotation and hip flexion while balancing on one leg Ilipsoas bursa affected- snapping in medial groin Management: do not permit to continue activity until seen by physician; cold to decrease pain and inflammation

D. Trochanteric bursitis

Women runners who have a wider pelvis and larger Q angle are at a greater risk of developing: A. Gluteus medius strain B. Pes anserinus bursitis C. Iliopsoas bursitis D. Trochanteric bursitis

B. Activation of EMS E. Fit the individual with crutches for transport

The management for a suspected hip dislocation includes: A. Immediate physician referral B. Activation of EMS C. Application of cold and compression D. Assess and treat for shock E. Fit the individual with crutches for transport

A. Hip flexion D. Knee extension

The rectus femurs is responsible for what motions? A. Hip flexion B. Hip extension C. Knee flexion D. Knee extension

Femoral Neck

The weakest component of the femur is the:

D. Flexed and internally rotated

When the head of the femur displaces in a posterior superior direction during a hip dislocation, the leg typically rests in what position? A. Extended and externally rotated B. Extended and internally rotated C. Flexed and externally rotated D. Flexed and internally rotated

A. Provides a site for muscle attachments C. Protects inner organs D. Provides a site for the femoral triangle

Which of the following are functions of the pelvis? A. Provides a site for muscle attachments B. Transmits loads between the trunk and the upper extremity C. Protects inner organs D. Provides a site for the femoral triangle

F. femoral shaft

Which of the following is considered a medical emergency that require activation of the emergency plan, including summoning of EMS? A. avulsion fracture of the AIIS with rectus femurs displacement B. stress fracture of the femoral neck C. slipped capital femoral epiphysis D. avulsion fracture of the ischial tuberosity with hamstrings displacement E. coccygeal fracture F. femoral shaft

A. It has the most ROM of any joint in the body B. It has the articulation of the head of the femur with the acetabulum of the pelvis E. It permits movement in all three planes

Which of the following statements describes the hip joint? A. it has the most ROM of any joint in the body B. it has the articulation of the head of the femur with the acetabulum of the pelvis C. it lacks bony stability D. it permits minimal movement E. it permits movement in all three planes