kin191 a.ch.8. pelvis. thigh. injuries

KIN 191AAdvanced Assessment of Lower

Extremity Injuries

THE PELVIS AND THIGHINJURIES

INTRODUCTION• MUSCLE STRAINS• BURSITIS• DEGENRATIVE HIP CHANGES• PIRIFORMIS SYNDROME• ILLIAC CREST CONTUSION• QUADRICEPS CONTUSION• HIP DISLOCATION• FEMUR FRACTURES/STRESS FRACTURES

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• SI JOINT DYSFUNCTION• OSTEITIS PUBIS• AVULSION FRACTURES (ASIS, AIIS, pubis, ischial tuberosity)

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MUSCLE STRAINS

• Typically associated with dynamic overload to eccentric contractions

• Pain usually felt at musculotendinous junction and/or at insertion site

• Most involved include quadriceps, hamstrings, hip flexors, adductors

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BURSITIS• Trochanteric– Either from direct trauma or repetitive friction

from IT band during knee flexion/extension– Often referred to as “snapping hip syndrome”

• Ischial– Either from direct trauma or movement in sitting

position (rowing, biking, etc.)• Iliopsoas– Anterior hip pain, difficult to differentiate from hip

flexor strain

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DEGENERATIVE HIP CHANGES

• Develop secondary to repetitive trauma, age, acute injury– Arthritis– OCD– Avascular necrosis

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PIRIFORMIS SYNDROME• “Sciatic” nerve proximity to

piriformis muscle• Spasm or hypertrophy of muscle

can produce “sciatica” – referred pain to buttocks or posterior leg

• May have pain with hip flexion motions

• Must evaluate sensory and motor function of involved structures

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ILIAC CREST CONTUSION

• Commonly referred to as “hip pointer”

• Attachment site for abdominal, lumbar and pelvic/hip musculature

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QUADRICEPS CONTUSION

• Significant bleeding leads to hematoma formation

• Typically presents with significant loss of ROM to knee flexion

• Risk of myositis ossificans• Must treat appropriately

acutely

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HIP DISLOCATION• Posterior more common

than anterior• Often associated with

femoral neck and/or acetabular fractures

• Classic presentation is adduction and internal rotation

• Neurovascular considerations

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FEMUR FRACTURES

• Involve significant trauma – atypical in athletics

• Present with immediate loss of function, pain and deformity

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STRESS FRACTURES

• Femoral shaft and neck are most common sites

• Difficult to differentiate from soft tissue injury (strain or tendonitis)

• Differential diagnosis made via bone scan

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SI JOINT DYSFUNCTION

• Collective term for multiple non-specific pathologies

• If accentuated motions occur at SI joint due to trauma or repetitive stress typically presents with rotation of ilium on sacrum

• May present as abnormal position due to muscle tightness/weakness or imbalances

• Must conduct comprehensive neurological evaluation since symptoms often replicate nerve root injury

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OSTEITIS PUBIS

• Chronic inflammatory condition at symphysis pubis from repetitive stress to area primarily from running

• May present with groin pain, pubic symphysis pain and discomfort with abdominal/hip adduction exercises due to muscular attachments

• Difficult to treat – may need injection

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AVULSION FRACTURES

• ASIS – Sartorius

• AIIS – Rectus femoris

• Pubis – Adductors

• Ischial tuberosity – Hamstrings

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