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

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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