injuries to pelvis and hip. anatomy of pelvis bones of pelvic girdle 1. ilium 2. ischium 3. pubis 4....
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Injuries to Pelvis and Hip
Anatomy of PelvisAnatomy of Pelvis
• Bones of pelvic girdle1. ilium2. ischium3. pubis4. sacrum** ilium, ischium, and
pubis combined form the 2 pelvic bones
• Articulations of pelvic girdle1. sacroiliac joint2. pubis symphysis
Pelvic Girdle
• Anatomy Of The Pelvis
Major Muscles of Pelvis
1. Hip Flexion• Iliopsoas
– Iliacus– Psoas Major
• sartorius• quadricep muscles
2. Abduction • gluteus medius• gluteus minimus• tensor fasciae latae
3. Adduction• adductor longus• adductor magnus • adductor brevis• gracilis• pectineus
4. Hip Extension• hamstrings• gluteus maximus
Muscles of the Pelvic and Hip
• Muscles of the Pelvic and Hip
Identification
• Identify the following:– Illium– Ischium– Pubis– Sacrum– Sacroiliac joint– Pubis symphasis– Iliac crest
Identification
• Identify the following:– Psoas Major– Iliacus– Tensor Fasciae Latae– Adductor Magnus– Adductor Brevis– Adductor Longus – Gracilias– Pectineus– Piriformis
Identification
• Identify the following:– Gluteus Maximus– Gluteus Minimus– Gluteus Medius
Blood Supply to Lower Extremities
• Arteries– Iliac – femoral – popliteal– tibial– peroneal
• Veins– iliac– femoral– saphenous– popliteal– tibial– peroneal
Blood Supply to Pelvis
• Pelvic Blood Supply– Iliac artery
• Internal• External
Injuries to Pelvic Region
• Fractures in Pelvic Region• Very rare in sports• Most common
1. stress
2. avulsion
• Symptoms1. altered gait
2. localized pain
Stress Fractures
• Stress Fx– Small crack in bone– Overuse injury– Uncommon in pelvic
area (1 to 7% of reported stress fx)
– Seen mainly in distance runners
– More common in females
Stress Fractures
• Stress Fx– Symptoms
• Chronic pain in pelvis area
• Gets worse with activity
– Diagnosis• X-rays and bone scans
– Treatment• Rest / no activity• Some may need
crutches for few days
Stress Fracture
Avulsion Fracture
• Avulsion Fx– Piece of bone pulls away at
tendon attachment site
– Caused when muscle contracts too rapidly or quickly (sudden stops, starts or jumping)
– Symptoms• May hear or feel a “pop”
• Immediate pain• Decreased ROM• Limping
Avulsion Fractures
• Avulsion Fracture– Treatment
• 4 to 6 weeks of rest• Physical Therapy
– Incidences• Rare but seen in sports
that require sprinting or rapid changes in movement
• Basketball, track and soccer
Avulsion Fractures
• Can occur at many points along pelvis– Iliac crest
– Anterior superior iliac spine (ASIS)
– Anterior inferior iliac spine (AIIS)
– Ischial tuberosity
– Pubic symphysis
Common Avulsion Fracture Sites
• Avulsion fx of left ischium
• Avulsion fx of anterior superior iliac spine
Avulsion Fracture
Hip Pointers
• Hip Pointers– Blow to the iliac crest– Causes bone bruise– Symptoms
• Point tenderness along iliac crest/spine
• Loss of ROM
– Treatment• Rest• Ice• ROM exercises• Donut shaped padding
Hip Pointers
Hip Pointers
Injuries to Pelvic Region
• Strains (Adductors or Hip Flexors)– Mechanism of Injury
1. extreme rotation
2. excessive abduction– Treatment
1. ice
2. stretch
3. leg strengthening
Anatomy of Hip and ThighAnatomy of Hip and Thigh
• Bones1. Femur2. Pelvic bone
• Articulations (Hip Joint)1. Head of femur2. Acetabulum of pelvis
bone** ball and socket joint
Bony Landmarks of Hip
• Hip Joint– Acetabulum
• “socket” for hip joint
– Femoral Head• “ball” for hip joint
– Greater trochanter– Lesser trochanter– Femoral neck– Femur
ROMS of Hip Joint
• Flexion
• Extension
• Abduction
• Adduction
• Medial Rotation
• Lateral Rotation
Major Muscles of HipMajor Muscles of Hip
• Hip flexion & Knee extension– Anterior thigh muscles
• Quadriceps Group –rectus femoris, –vastus medialus, –vastus lateralis, –vastus intermedius
Major Muscles of HipMajor Muscles of Hip
• Hip extension & Knee flexion– Posterior thigh muscles
• Hamstring Group – –Semitendinosus–Semimembranosus–Biceps femoris
Injuries to the Hip and ThighInjuries to the Hip and Thigh
• Fractures of Femur– Great force required to break femur– Contact sports, BMX, skateboarding,
motorcross increase risk– Splint, send to physician, or call EMS
Femur Fracture
Femoral Neck Fracture Repair
Injuries to the Hip and ThighInjuries to the Hip and Thigh
• Subluxation / Dislocation– Symptoms
1. complete loss of function2. severe pain3. deformity
– Mechanism of Injury1. direct blow2. twisting force
Dislocated Hip
Subluxation of the hip
Injuries to the Hip and ThighInjuries to the Hip and Thigh• Contusions
– “Charley Horse” = bruise to the quad muscles
– Mechanism of Injury• Direct blow to thigh causing bleeding in the muscle
tissue
– Treatment1. ICE2. keep knee flexed while applying ice3. mild stretching through pain free ROM** if stretching is not done, blood will pool and leave
area vulnerable to myositis ossificans
Injuries to the Hip and ThighInjuries to the Hip and Thigh
• Sprains– Mechanism of injury
1. sudden jerking or twisting motions2. more frequent in non or poor conditioned athletes
– Treatment• PRICE• Stretching & ROM exercises• If injury doesn’t improve within 3 days, send to
physician
Injuries to the Hip and ThighInjuries to the Hip and Thigh
• Strains– Most common = hamstrings, hip flexor,
adductors and quad
– Treatment• ICE• Stretching• Strengthening
Injuries to the Hip and ThighInjuries to the Hip and Thigh• Bursitis / Synovitis
– Most common is inflammation of the trochanter bursa
– Mechanism of Injury1. direct blow2. repeated stress
– Symptoms1. slight swelling2. persistent ache
– Treatment1. rest2. stretching
Special Tests for Hip and PelvisSpecial Tests for Hip and Pelvis
• Thomas Test – hip flexor flexibility
Negative
Positive
Special Tests for Hip and PelvisSpecial Tests for Hip and Pelvis
• Ober’s Test – Iliotibial (IT) band flexibility
Iliotibial (IT) Band
Stretches for IT Band
Special Tests for Hip and PelvisSpecial Tests for Hip and Pelvis
• Patrick’s or Faber Test – deformity or weakness of the iliopsoas muscle and sacroiliac pain
Special Tests for Hip and PelvisSpecial Tests for Hip and Pelvis• Trendelenburg Test – hip abductor
weakness