Chapter 14- Pelvis, Hip , and Thigh Conditions

Snapping Hip Syndrome

A condition very prevalent in dancers, runners, and cheerleaders. Signs and Symptoms of Snapping Hip Syndrome Snapping Hip Syndrome is characterized by a sensation, rather than pain, either heard or felt during certain motions at the hip. It usually occurs when an individual laterally rotates and flexes the hip joint while balancing on one leg. Management of Snapping Hip Syndrome Management for this condition is the same as bursitis.

Hip Pointer

A hip pointer refers to a contusion of the iliac crest. Signs and Symptoms of Hip Pointer Any movement of the trunk is painful, including coughing, laughing and even breathing. Extreme tenderness is present over the iliac crest, and abdominal muscle spasm may be present. Management The immediate management involves the application of ice and compression wrap of the area. This injury often requires total rest during the first 2 to 3 days following injury.

Kinematics and Major Muscle Actions of the Hiptednd

Because the hip is a ball- and socket joint, the femur can move in all plaves of motion. Flexion The major hip flexors are the iliacus and psoas major , referred to jointly as the iliopasoas. Extension The hip extensors are the gluteus,_maximus and the three hamstrings: the biceps , femoris, semitendinosus , and semimenbranosus. Abduction The Gluteus medius is the major abductor at the hip. Adduction The hip adductors include the adductor longus, adductor brevis, and adductor magnus. The hip adductors also contribute to flexion and internal_rotation at the hip.

Bursitisric

Bursitis is common in runners and joggers. It typically affects the greater trochanteric bursa, iliopsoas, and ischial bursa .Common mechanism is inflammation secondary to excessive friction or shear forces caused by overuse. Greater Trochanteric Bursitis Inflammation of this bursa is seen more often in females because of the wider pelvis and larger Q- angle. Signs and Symptoms of Greater Trochanteric Bursitis The individual reports a burning or aching pain over or just posterior to the top of the greater trochanter that intensifies with walking or exercise. Ilipsoas Bursitis The iliopsoas bursa, the largest bursa in the body, can be irritated when the iliopsoas muscle repeatedly compresses the bursa against either the joint capsule of the hip of the lesser trochanter of the femur. Signs and Symptoms of Ilipsoas Bursitis Pain is felt more medial and anterior to the joint, and cannot be easily palpated. Ischial Bursitis Direct bruising from a fall can lead to compression of the ischial bursa. Signs and Symptoms of Ischial Bursitis Pain is aggravated by prolonged sitting, uphill running, and even carrying a wallet in the back pocket. Management of Ischial Bursitis The individual should be referred to a qualified healthcare for a definitive diagnosis and ongoing treatment options.

Contusions

Direct impact to soft tissue, causes a compressive force to crush soft tissue. Contusions may occur anywhere in the hip region, but are typically seen on the crest of the ilium or in the quadriceps muscle group.

Bursae

Four primary bursae are present in the hip and pelvic region. The iliopsoas bursa is positioned between the iliopsoas and articular capsule, serving to reduce the friction between these structures.

Femoral Fractures

Fractures of the femoral shaft can be very serious because of potential damage to the neurovascular structures from bony fragments. Femoral shaft fractures are caused by tremendous impact forces. Signs and Symptoms of Displaced and Nondisplaced Pelvic Fractures Severe pain and a total loss of functions are associated with this injury. Management of Displaced and Nondisplaced Pelvic Fractures If a fracture is suspected, the emergency plan should be activated, including summoning EMS.

Sacral and Coccygeal Fractures

Fractures of the sacrum and coccyx rarely occur in sports. They are typically caused by a direct blow onto the sacrococcygeal area subsequent to a fall on the buttock region. Signs and Symptoms of Displaced and Nondisplaced Pelvic Fractures Subsequent to pain, the individual is unable to sit. Management of Displaced and Nondisplaced Pelvic Fractures The individual should be referred immediately to a physician.

Strains and Dislocations

Hip joint sprains are rare because of the multitude of movements allowed at the ball- and- socker joint and the level of protection provided by layers of muscles that add to its stability. Injury can occur in violent twisting actions or in catastrophic trauma when the knee strikes a stationary object. Signs and Symptoms Symptoms of a mild or moderate hip sprain involve pain on hip rotation. Management The immediate management for a mild or moderate sprain involves the application of cold to the area, and referral to a qualified healthcare practitioner. A hip dislocation is considered a medical emergency.

Avulsion Fracturesopophys

Individuals who perform rapid, sudden acceleration and deceleration are at risk for the following avulsion fractures. Many of these apophyseal sites do not unite with the bone until ages 8 to 25, and as such , continue to be prone to fracture. Signs and Symptoms of Avulsion Fractures The individual complains of sudden , acute, localized pain that may radiate down the muscle. Pain increases with passive stretching of the involved muscle and active/resisted ROM. Management of Avulsion Fractures The individual should be referred immediately to a physician.

The Coach and On site Assessment of a pelvis, hip , or thigh Condition

It is important for the coach to recognize that while many injuries to this region are not life-threatening , there are some conditions that will require activation of the emergency plan. The focus should be on observing the individuals overall presentation , attitude, and general posture, with a particular focus on their willingness or ability to move and their apparent pain level. When it becomes apparent that an injury is ____ in nature, the ____ should refrain from any continued ____ and , instead, refer the individual to an appropriate _______ practitioner.

Legg- Calve-Perthes Disease

Legg- Calve-Perthes Disease or avascular necrosis of the capaital femoral epiphysis, is a _ noninflammatory, self-limiting disorder of the hip seen in young children, especially males, between the ages of 3 and 8. It is considered to be a osteochondrosis condition of the femoral head, caused by diminished blood supply to the capital region of the femur. Signs and Symptoms of Legg- Calve-Perthes Disease The most common complaint is a gradual onset of a limp and mild hip or knee pain of several months duration. The pain is most often referred to the groin region. Management of Legg- Calve-Perthes Disease This condition should be suspected in Young children when pain in the groin, anterior thigh , or knee region cannot be explained. The coach should not permit the individual to continue activity.

Fractures

Major fractures of the pelvic girdle, hip , and femur often result from severe direct trauma. In some sports , the pelvic region is usually adequately protected by padding to prevent such injuries.

Displaced and Nondisplaced Pelvic Fractures

Major fractures of the pelvis seldom occur in sport participation except in activities such as equestrian sports, ice hockey, rugby, skiing , and football. Because the pelvis is a closed ring, an injury to one location in the pelvis can cause a countercoup fracture or sprain on the other side of the pelvic ring. Signs and Symptoms of Displaced and Nondisplaced Pelvic Fractures This crushing injury produces severe pain, total loss of function , and in many cases, severe loss of blood leading to hypovolemic shock. Managament of Displaced and Nondisplaced Pelvic Fractures If a fracture is suspected, the emergency plan should be activated, including summoning EMS.

Myosistis Ossificans

Myosistis Ossificans is an abnormal ossification involving bone deposition within muscle tissue. It may stem from a single traumatic blow, or repeated blows, to the quadriceps. Signs and Symptoms Examination reveals a warm, firm, swollen thigh nearly 2 to 4 cm larger than the unaffected side. Management This individual should be referred to a physician.

Strains

Quadriceps Strain A strain of the quadriceps is less common than hamstring strains. Signs and Symptoms of Quadriceps Strains In a Grade 1 injury, the individual complains of tightness in the anterior thigh, but gait is normal. In a Grade II injury, the individual reports a snapping or tearing sensation during an explosive jumping, kicking, running motion. Grade 3 are extremely painful. An obvious defect in the muscle may be visible. Hamstrings Strain The hamstrings are the most frequently strained muscles in the body and are typically caused by a rapid contraction of the muscle during a ballistic action or a violent stretch. Signs and Symptoms of Hamstrings Strains In mild strains, the individual complains of tightness and tension in the muscle. In second - and this- degree strains, the individual may report a tearing sensation or feeling a pop. A hamstrings strain has a reputation of being both chronic and recurring. Adductor ( Groin ) Strain The more severe strains are typically at the muscles proximal attachment on the hip, particularly the adductor longus. Milder strains tend to occur more distally at the musculotendinous junction. Signs and Symptoms of Adductor ( Groin ) Strain The individual often experiences an initial twinge or pull of the groin muscles, and is unable to walk because of the intense, sharp pain. Management of Strains If a Grade I injury is suspected, management involves standard acute care with cold and compression. If a grade II or III injury is suspected, standard acute management , including the use of tioner, should be used.

Stress Fractures

Stress fractures to the publis, femoral neck , and proximal third of the femur are seen in individuals who engage in extensive jogging or aerobic dance activities. Signs and Symptoms of Stress Fractures Usually involve a diffuse or localized aching pain in the anterior groin or thigh region during weight - bearing activity that is relieved with rest. Management of Stress Fractures The individual should be referred to a physician for a definitive diagnosis and ongoing treatment options.

Sacroiliac Joints

The SI joints form the critical link between the two pelvic bones. Working with the public symphysis, they help to transfer the weight of the torso and skull to the lower limbs.

Slipped Capital Femoral Epiphysis

The capital femoral epiphysis is the growth plate at the femoral head. In particular , the condition is commonly seen in obese adolescents with underdeveloped sexual characteristics. In a Slipped Capital Femoral Epiphysis , the femoral head slips at the epiphyseal plate and displaces inferiorly and posteriorly relative to the femoral neck. Signs and Symptoms of Slipped Capital Femoral Epiphysis Early signs and symptoms may go undetected. Frequently, the only complaint is diffuse knee pain. Management of Slipped Capital Femoral Epiphysis The individual should be referred to a physician for a definitive diagnosis and ongoing treatment options.

Femoral Triangle

The femoral triangle is formed by the ligament ligament superiorly, the sartorius laterally, and the adductor longus medially.

The Femur

The femur, a major weight-bearing bone, is the longest, largest, and strongest bone in the body.

The Hip Joint

The hip is the articulation between the concave acetabulum of the pelvis and the head of the femur. It functions as a classic ball - and -socket joint. The joint capsule of the hip, the coxofemoral joint, is large and loose. Increased fluid pressure within the labrum contributing to lubrication of the joint. Sometimes referred to as the Y ligament of Bigelow, limits hip hyperextension and plays a major role in maintaining upright posture at the hip.

Prevention of Pelvis, Hip, and Thigh Conditions

The hip joint us well protected within the pelvic girdle and is seldom injured.

Nerves and Blood Vessels of the Pelvis, Hip and Thighilicac

The major nerve supply to the pelvis, hip, and thigh arises from the lumbar and scaral plexi. The lumbar Plexus is formed form the first four lumbar spinal nerves. ( L2-L4) The largest branch is tn of the anterior thigh. The sacral pexus is positioned just anterior to the lumbar plexus, and has some intermingling of fibers with the lumbar plexus. The major nerve is the sciatic nerve, which is the largest and longest single nerve in the body. The external iliac arteries become the femoral arteries at the level of the thighs.

Quadriceps Contusionu

The most common site for a quadriceps contusion is the anterolateral thigh. Severity of the injury is almost always underestimated and undertreated. Signs and Symptoms Pain and swilling may be extensive immediately after impact. Management Treatment involves ice application and a compressive wrap for the first - 24 to 48 hours applied with the knee in maximal flexion.

The Pelvis

The pelvis consists of a protective bony ring formed by four fused bones, namely the two innominate bones, sacrum and coccyx. Each innominate bone consists of three fused bones, namely the ilium, ischium , and pubis.

Pubic Symphysis

The pubic symphysis is a cartilaginous joint with a disc of fibrocartilage, called the interpublic disc, located between the two joint surfaces.

Medial and Lateral Rotation of the Femur

There are six that function as lateral rotators. These are the piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, and quadratus femoris. The major media rotator of the femur is the glutesus minumus.

Vascular and Neural Disorders

Vascular disorders should be suspected in any lower extremity injury caused by a high - velocity, low-mass projectile . If an acute circulatory problem exists, the lower leg and foot may appear pale or cyanotic, be cool to the touch , or have diminshed or totally absent pulse.