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Hip Labeling

Hip Labeling. Sports med 2. The Hip. Sports Med 2. The Hip. A ball and socket joint Hip transmits the load from the foot to the spine and vice versa. Blood & Nerve Supply. Femoral artery Common Iliac Vein Femoral Nerve Sciatic Nerve Largest nerve in the body

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Hip Labeling

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  1. Hip Labeling Sports med 2

  2. The Hip Sports Med 2

  3. The Hip • A ball and socket joint • Hip transmits the load from the foot to the spine and vice versa

  4. Blood & Nerve Supply • Femoral artery • Common Iliac Vein • Femoral Nerve • Sciatic Nerve • Largest nerve in the body • Innervates thigh and lower leg

  5. Bursae • Iliopsoas and deep trochanteric bursae • Most important ones

  6. Injury • Trochanteric Bursitis • MOI: • Common at the greater trochanter, high in women w/ increased Q angle, or leg length discrepancy • Inflammation of bursa, or insertion of gluteus medius, or IT band • S/S: • c/o pain on lateral hip • Radiating pain down to the knee • Tenderness over greater trochanter • TX: • PRICE, NSAIDS, ROM, PREs, no inclined running • Special Tests: Obers,

  7. Ober’s Test Athlete lays on unaffected side Knee flexed at 90 degrees Lift top leg into abduction, slight hip extension Allow the affected leg to drop into adduction If leg does NOT drop = + tight IT band

  8. Bones • Sacrum, Coccyx • Innominate bones: ossify and fuse early in life • Pelvis • Support the spine and trunk • Transfer their weight to the lower limbs • Placement for bony attachment • Ilium, Ischium, Pubis • Make up pelvis

  9. Injuries • Hip Pointer (contusion) • MOI • blow to inadequately protected iliac crest • Most handicapping injury in sports, difficult to manage • S/S • Immediate pain, spasms, transitory paralysis of soft structures • Unable to rotate the trunk or to flex the thigh with out pn • TX • RICE, referral, x-ray, ice massage, ultrasound, injection • Doughnut pad for return to play

  10. Hip dislocation

  11. Injuries • Hip Dislocation pg 727 fig. 21-30 • MOI • Rarely occur during sports, major trauma • Femur is adducted and flexed • S/S • Flexed, adducted, and internally rotated thigh • Deformity, nerve damage • TX • Immobilization, ice, analgesics

  12. Injury • Avulsion Fracture • MOI: • Most common: 1) ischialtuberosity (hamstrings), 2)AIIS(rectus femoris), ASIS (sartorius) • Sudden acceleration/deceleration • S/S: • Sudden local pain • Limited movement • TX: • X ray, PRICE, crutches, ROM, Progressive Resistance Exercises (PREs) • Special Tests: Hip MMTs

  13. Injury • Osteitis Pubis • MOI: • running sports (XC, football, soccer, wrestling) • Repetitive stress on pubis symphysis by surrounding muscles • S/S: • Groin pain while running, squats, sit ups • TX: rest, NSAIDS, gradual return to play • Special Tests: running, sit up, squats

  14. Articulations • Sacroiliac Joint • Supported by ligaments • Connects sacrum to ilium • Joint Capsule • The acetabulum is cushioned by the labrum • Hip Joint • Made of femur head and acetabulum • Padded at the center by a mass of fatty tissue, ligaments and capsule

  15. Ligaments • Iliofemoral • Y ligament of Bigelow • Strongest ligament of body • Prevents hyperextension • Pubofemoral • Prevents excessive abduction

  16. Ligaments • Ischiofemoral • Prevents internal rotation and adduction • On posterior aspect • Ligamentum Teres • Ligament to the head of the femur • A bridge to allow blood vessels and nerves to enter the head of the femur

  17. Injuries • Hip Sprain • MOI • Strong = best protected, seldom injured • Violent twisting produced by opponent, foot firmly planted and trunk forced in opposing direction • S/S • Athlete is unable to circumduct the thigh • pain • TX • X-rays to rule out fx • RICE, analgesics, limit wt. bearing, pain free ROM • Special Tests: active circumduction of thigh, IR, ER

  18. IR/ER

  19. Injuries • Sacroiliac Joint Sprain (S.I. Joint) • MOI • Twists with both feet on the ground • Stumbles forward, falls backward, steps in hole • S/S • Pain over joint, muscle guarding, radiating pain down back of gluteus and hamstring • Asymmetrical ASIS/PSIS or leg length difference • TX • Modalities, brace, stability exercises • Special Test: FABERS/Patricks

  20. FABERs /Patrick Test • Procedure: Place foot on the opposite extended knee of the painful SI joint • Apply pressure downward on the bent knee. • Positive test: Pain felt in hip or SI jt. = SI joint dysfunction

  21. Muscles • Anterior • Iliacus • Triangular shaped, flexes the hip • Psoas (major and minor) • Flexes the hip • Sartorius • Crosses medially across anterior thigh • Hip flexion, and external rotation • Rectus Femoris • Hip flexion and knee extension

  22. Muscles • Lateral • Tensor fascia latae • Hip abduction • Posterior • Piriformis- ext. rotation • 3 gluteal muscles • Gluteus Maximus: extension, adduction, helps us get up from a sitting position • Gluteus Medius: abduction • Gluteus Minimus: abduction • Hamstrings: hip extension, knee flexion • Biceps Femoris, Semitendinosis, Semimembranosus

  23. Piriformis stretch

  24. Hip Abduction • Practice Hip MMTs for abduction adduction, and flexion • Practice the piriformis stretch

  25. Muscles • Medial • adductors and rotators of the hip • Gracilis • Adduction, external rotation • Pectineus • Adduction, external rotation • Adductor longus, brevis and magnus • Adduction, external rotation

  26. Injuries • Groin Strain (adductor/Hip flexor strain) • MOI • Torn during twist or pull while running or jumping • S/S • Feel twinge or tearing during an AROM • may feel worse the next day • Pain, weakness, bruising • TX • PRICE, analgesics, ROM and PREs • Rest is the best treatment, protective spica • Special Tests: MMTs

  27. Thomas Test • Procedure: Athletes lies supine legs together • ATC places on hand under athletes lumbar curve • One thigh is brought to the chest flattening the spine. • Return bent leg to extended position, lumbar curve should return. • Positive Test: Extended thigh should be flat on the table, if not = tight hip flexor

  28. Kendall test Procedure: Athlete lies supine with knees off table Athlete brings one leg to their chest Positive Test: If thigh comes off the table = tight hip flexor

  29. Injury • Quad Contusion • MOI • Direct blow to the thigh • TX: flx w/ice pack ,PRICE,NSAIDS, PREscrutches

  30. Injury • MyositisOssificansTraumatica • MOI: • Severe blow or repeated blows to thigh, usually the quadriceps • Can lead to ectopic bone production (myosositisossificans) • S/S: • Pain, swelling, decreased function • TX: • Conservative, surgery one year later • Special Tests: • AROM knee flexion/ext

  31. Injury • Hamstring Strain • MOI • Most common injury to thigh, exact cause not known • Possible MOI: muscle fatigue, faulty posture, leg length discrepancy, tight hamstrings • S/S • Hemorrhage, pain, loss of function. • 3 grades of strain • TX • PRICE, NSAIDS, very conservative, PREs • Special test: MMTs

  32. Hamstring MMT

  33. Injury • Snapping Hip: • Excessive repetitive movement in dancers, gymnasts, hurdlers, sprinters • MOI: • Imbalance in muscle • IT band moves over the greater trochanter • S/S: • c/o of snapping with pain • TX: • Ice, NSAIDS, ultrasound, then stretching and strengthening

  34. Trendelenburg’s test Procedure: Athlete stands, foot on the unaffected side is lifted Look at the iliac crest to see if it stays level Positive test: if unaffected side lowers OR If standing on leg and affected hip moves into abduction = Weak abductors

  35. Injury • Femoroacetabular impingement (FAI) • Hip Impingement • MOI • abutment of the acetabular rim and the proximal femur • Bone abnormalities, congenital or developed • S/S • Anterolateral hip pain • aggravating activities: prolonged sitting, leaning forward, getting in or out of a car, and pivoting in sports. • TX • Analgesics, ROM, PREs • Refer to Ortho

  36. Special Test • FADIR • Flexion adduction internal rotation • Procedure: Flex, adduct, and internally rotate the leg • Positive test: anterolateral hip pain

  37. Measuring for Leg length • 2 main ways: • Anatomical discrepancy • Functional discrepancy

  38. Anatomical discrepancy(true method) ASIS (actual bone is shortened) Athlete lies supine with legs straight Measurement is taken between the medial malleoli and ASIS Bilaterally compare Malleoli

  39. Functional discrepancy Due to pelvic tilt or deformity Athlete lies supine, legs straight Measurement is taken from umbilicus to the medial malleoli Bilaterally compare

  40. Hip Assessment Sports Med 2

  41. History • What are your symptoms • Weakness, disability, pain • Can they move their leg in a circle? • Describe pain • felt mainly in groin and medial frontal part of the thigh, can also refer to the knee • Is it radiating, tingly, dull, achy? • When does the activity occur? • How old is the athlete?

  42. Observation • Should observe while standing in all directions, standing on one leg, and walking • Front view • Are the hips even? • lateral tilted hip could = a leg length discrepancy or muscle contraction on one side • Side view • Abnormal tilt of the pelvis, anterior/posterior • indicate lordosis or flat back

  43. Observation • Lower limb alignment • Genu valgum (knocked knees) • Genu varum (bow legged) • Genu recurvatum (hyper-extended) • Patellar alignment • Even PSIS • indicate a lateral shift of the pelvis • Standing on one leg could produce hip pain, indicate pain in pubic symphysis, or abductor weakness • Ambulation: observe while walking and sitting • Walking will cause distortion

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