Injuries to the Hip and Pelvis

We will discuss a basic overview of the anatomy in the region of the hip and pelvis

We will have a brief description of movements by the joints and actions of the musculature in the area

We will target more common hip and pelvis injuries incurred in sports and outlines emergency procedures

We will also talk about injuries that aren’t common in sports

The chapter reviews injuries to the male genitalia, including both testicular contusion and torsion

It also covers hernia and nerve problems and discusses proper referral

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Anatomy Review…The hip and pelvis

form a square in the way they are constructed

This area comprises the two large, irregularly shaped pelvic bones on the lateral sides, the sacrum and coccyx posteriorly, and the articulation of the pubic bones anteriorly

Anatomy Review…The pelvic bones

are also known as the innominate bones and are made up three distinct parts:◦ The ilium◦ The ischium◦ And pubis

Anatomy Review…In the adult, the

three parts are fused and come together at a lateral point called the acetabulum, which is where the head of the femur articulates with the hip to form the hip joint

Anatomy Review…The bony pelvis has several

functions in the body:◦The lower extremities attach here◦Muscle attachments are prevalent◦It provides substantial protection for

the entire pelvic region

Anatomy Review…The major articulations of the

bony pelvis include the hip joint, the sacroiliac joints, and the symphysis pubis

The hip joint is the articulation of the head of the femur and the acetabulum in the hip bone; it is a true ball-and-socket joint that is well supported by strong ligaments

Anatomy ReviewThe sacroiliac joints are formed

by the sacral bones and the iliac portion of the hip bones

The symphysis pubis is formed by the two pubic bones meeting in anterior portion of the bony pelvis

All of these joints have strong ligamentous support that assist in joint stability

Anatomy Review…Several nerves and

blood vessels course through the bony pelvis

Some of the more important nerves that course down the lower extremity are subdivisions of the make up of the cauda equina

Anatomy Review…The spinal cord ends

at L2 level, and the cauda equina exits the spinal cord beginning at L2 and proceeding inferiorly (Gray, 1974)

Nerves exiting the spinal cord below the L1 level typically pass through the bony pelvis

Anatomy Review…These nerves include the

formation of the lumbar plexus, the sacral plexus, the coccygeal plexus and other individual nerves

Probably the most well known of these is the sciatic nerve, which is the largest in the body and is made up of nerve roots L4 – S3

Anatomy Review…The sciatic nerve

passes through the posterior portion of the bony pelvis and down the posterior aspect of the leg

The blood vessels of the area include both arteries and veins that supply the pelvis and lower extremities

The more well known of these vessels include the iliac artery and vein

Anatomy Review Many of the muscles that

attach to the bony pelvis are ones that move the lower extremities

The smaller muscles consist of the medial and lateral rotators of the femur

Some of the medial rotators include the tensor fasciae latae and gluetus minimus

These muscles are quite active in many movements of the lower extremity

Anatomy Review…The lateral rotators of

the hip are small muscles located deep within the hip area that are also quite active in many movements of the lower extremity

Some of those muscles more commonly injured include the piriformis◦ Which attaches to the

anterior surface of the sacrum and to the greater trochanter of the femur

Anatomy Review…The piriformis is

a lateral rotator of the thigh; the sciatic nerve runs directly beneath the piriformis and can be irritated by the overuse of this muscle

Anatomy Review…Other external

rotators of the thigh include the gemelli (superior and inferior), which attach on the ischium and run to the greater trochanter of the femur

Anatomy Review…All of these muscles are small in

comparison with the surrounding muscles, but they play an important part in the proper functioning of the hip and leg

Many muscles attach on the pelvis and provide musculature for the leg, back, and abdomen

These muscles responsible for many of the large movements at the hip joint include flexors, extensors, adductors, and abductors

Anatomy Review…The main hip flexors

include the rectus femoris, the iliopsoas group, the tensor fasciae latae, and the sartorius

The rectus femoris attaches at the ASIS and runs down the front of the leg to the common attachment of the quadriceps group at the patellar tendon

Anatomy Review…The iliopsoas group is a combination of the

iliacus and psoas muscles, which attach on the anterior lumbar spine and iliac crest and come together as they run down to the lesser trochanter of the femur

Anatomy Review…The tensor fasciae latae

and sartorius attach on the anterior iliac spine

The tensor fasciae latae runs to the lateraly condyle of the tibia, whereas the sartoris runs across the anterior thigh and attaches to the anterior medial aspect of the tibia

The sartorius becomes one of the muscles of the pes anserinus group

Anatomy Review…The main muscles of

hip extension are the gluteals and the hamstrings

The gluteus maximus is the main hip extensor of the gluteals

Attaches on the posterior surface of the ilium and runs inferiorly to the femur

Anatomy Review… The hamstrings attach mainly on the ischial tuberosity;

then, two of the muscles, the semitendinosus and semimembranosus, run more medially on the posterior leg and attach near the sartorius and on the posterior/medial condyle of the tibia

The biceps femoris runs more laterally on the posterior leg and attaches to the lateral aspect of the tibia and head of the fibula

Anatomy Review…The muscles that

adduct the hip are located on the medial portion of the leg are commonly called the groin area

Main muscles included in this group are the three adductors (brevis, longus, magnus) as well as the pectineus and gracilis

Anatomy Review…The adductors attach on the

pubis and run to the femurThe pectineus also attaches at

the pubis and runs to the femurThe gracilis attaches on the

inferior portion of the pubis and runs medially down the leg to the anterior medial portion of the tibia

Anatomy ReviewThe sartoris, gracilis

and the semitendinosus compose the pes anserinus group

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Common Sports Injuries…The Sports-related injuries to the Injuries to the soft tissues in the

region are more Injuries commonly involve collision

sports or Overuse injuries may also be

associated with the hip and pelvis

Skeletal Injuries…FX of the PelvisOne of the most devastating injuries

to the pelvic region is the Typically, a great deal of force is

necessary to cause a fracture of this type

This is not a Still, it can occur in sports such as

hockey, pole-vaulting, or football in which there is the possibility of

Skeletal Injuries…FX of the PelvisSkeletal injuries to

the pelvis in the adolescent population can be extremely serious,

Any suspected skeletal injury to this area should be referred to a physician as quickly as possible

Skeletal Injuries…FX of the PelvisS&S:

◦ Abdominal pain in the ◦ There might be swelling

at the site, ◦ Pain is elicited when the

◦ Associated injuries to internal organs such as the bladder are possible and should be ruled out

TX:◦ Treat for possible

shock and internal bleeding

◦ Monitor the athlete’s vital signs regularly

◦ Transport the athlete to the hospital on a long spine board with the

Skeletal Injuries…FX of the pelvisA fracture of the pelvis is a serious

injury and Treatment depends on the severity of

the injury and should be complete before the athlete returns to practice or competition

Under return to competition before seeing a physician

Femoral Neck Stress FractureThis injury occurs

more commonly in the

The femoral neck stress fracture is a result of a loss in shock-absorbing capacity of the fatigued muscles in the hip area

Femoral Neck Stress FractureThis problem can also be a partial result

of (Lacroix, 2000)Typically, athletes c/o The athlete will be able to walk but will

experience pain during ambulationSeeing a physician is necessary to get

radiographs

Slipped Capital Femoral EpiphysisThis problem occurs most commonly in Typically, it occurs in boys who are tall

and have recently experienced a rapid growth period, or in boys who are overweight

The boy exhibits a flexed hip, thigh or knee

Any child younger than the age of 12 who complains of knee pain should have a thorough

Hip PointerProbably the most common injury

to the region is a

Typically, with this injury the athlete receives a direct blow to the area from an opponent’s helmet or falls to the ground with great force

Hip PointerThis can be an

extremely painful and debilitating injury for the athlete,

Hip PointerS&S:

◦ Swelling at the site of injury

◦ Discoloration at the site of injury

◦ Pain and discomfort at the site of injury

◦ The athlete may walk with a slight limp on the affected side Coughing,

TX:◦ Immediately apply

ice to the injured area

◦ Have the ◦ If the injury is

severe, walking with crutches may be necessary for a few days

Hip PointerLong-term care for this type of

injury is rather simpleThe contusion has in most cases

caused The muscular attachments The player will usually be able to

participate on a limited basis within 1 to 2 weeks, depending on the severity

Hip PointerIt is important to note that if an

athlete wishes to continue participation in sports while recovering from a hip pointer,

Other Hip ProblemsAthletes who participate in

excessive running as a part of their sport can experience what is known as “ ”

Snapping hip syndrome is a Usually, there is little if any pain

associated with snapping hipThis problem is attributed to one

of the

Other Hip Problems…The structures that could be

involved include the There could be that induce extra

movement of the femur during locomotion

Typically, treatment consist of stretching tightened muscles that may contribute to

Anti-inflammatory medications may help

Other Hip Problems…Trochanteric bursitis is another rare

problem experienced by some athletesIt is a problem seen most often This bursitis is usually a result of either

acute trauma to the specific area or repeated

Other Hip Problems..The and the athlete continues to run

when he/she is experiencing S&S of trochanteric bursitis

When an athlete is experiencing the onset of trochanteric bursitis,

Other Hip Problems..Most athletes benefit from For some athletes, it may be necessary to

pad the area if there is a chance of external trauma such as falling or being hit by another athlete in the hip

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Osteitis PubisAnother type of skeletal injury to the

pelvic area is This injury is commonly a result of

overuse and chronic strain on the jointLong-distance runners, basketball and

soccer players, and

Osteitis PubisAthletes who produce during their

sport participation are more susceptible to this problem

Osteitis pubis is a difficult injury to diagnose because the many muscles and structures in the pelvic area,

Osteitis PubisS&S

◦ c/o an insidious onset of pain that worsens progressively

◦ May

TX:◦ Should be referred to

the appropriate doctor for complete evaluation

◦ Because this is a chronic problem,

◦ Athlete may benefit from RICES

Osteitis PubisThe athlete typically responds

well to

An athlete may take anywhere from 3 months to a year to return to preinjury functioning levels

Injury of the Sacroiliac Joint…The sacroiliac (SI)

joint, which is the articulation between the sacrum and pelvis,

Movement of this joint is limited because of the

Injury of the Sacroiliac Joint…This joint can present problems for

the athlete if it becomes Injuries resulting in an immobile SI

joint require specific Problems with inflammation in the

SI joint can be treated by a certified athletic trainer or physical therapist under the direction of a physician

Hip Dislocation…Infinitely This injury is actually quite rare in athletic

events; however, If a violent collision occurs between two

players or between a player and another object (for example, the boards surrounding a hockey rink), this type of injury can happen

Typically, Most often the hip dislocates posteriorly, and

the athlete experiences extreme pain and loss of movement in the affected extremity

Hip DislocationS&S:

◦ Abnormal pain at the site of injury

◦ Swelling at the site of injury,

◦ Knee of the involved extremity is angled toward the opposite leg

◦ This injury is typically quite visible to the observer

TX:◦ Treat for possible

shock◦ Immobilize the

athlete and transport to the nearest medical center

◦ Care

Soft-tissue Injuries…Because of the size and functions

of the musculature in the hip and pelvic region,

The ligamentous support of the hip, sacrum, and other structures in the area is very strong; as a result, sprains rarely occur here

however, several muscles attach in the area of the pelvis,

Avulsion Fractures…