Thigh, Hip, and Pelvis

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  1. Femur Anatomy
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  2. Hip/Pelvis Anatomy
    • •The primary muscles are the iliopsoas,
    • rectus femoris, gluteal muscles, the adductor muscles, and the external rotators.
  3. Nerve and Blood Supply
    •Tibial and common peroneal are given rise from the sacral plexus which form the largest nerve in the body the sciatic nerve complex

    • •The main arteries of the thigh are the deep circumflex femoral, deep femoral, and
    • femoral artery

    •The two main veins are the superficial great saphenous and the femoral vein
  4. Fascia
    •The fascia lata femoris is part of the deep fascia that invests the thigh musculature

    •Thick anteriorly, laterally and posteriorly but thin on the medial side

    • •Iliotibial track (IT-band) is located laterally serving as the attachment for the tensor
    • fascia lata and greater aspect of the gluteus maximum
  5. Functional Anatomy of the Thigh
    •Quadriceps insert in a common tendon to the proximal patella

    •Rectus femoris is the only quad muscle that crosses the hip –Extends knee and flexes the hip

    • •Hamstrings cross the knee joint posteriorly and all except the short of head of the biceps
    • crosses the hip

    •Bi-articulate muscles produce forces dependent upon position of both knee and hip

    •Position of the knee and hip during movement and MOI play important roles and provide information to utilize w/ rehab and prevention of hamstring injuries
  6. Functional Anatomy Pelvis
    •Pelvisbmoves in three planes through muscle function

    • –Anterior tilting changes degree of lumbar lordosis, lateral tilting changes degree of
    • hip abduction

    •Hip is a true ball and socket joint w/ intrinsic stability

    •Hip also moves in all three planes, particularly during gait (body’s relative center of gravity)
  7. •Tests for Hip Flexor Tightness
    –Kendall test 

    • •Test for rectus femoris
    • tightness

    –Thomas test
  8. Femoral Anteversion (A) and Retroversion (B)
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  9. Femoral Anteversion (A) and Retroversion (B)
    –Relationship between neck and shaft of femur

    –Normal angle is 15 degrees anterior to the long axis of the femur and condyles

    –Internal rotation in excess of 35 degrees is indicative of anteversion, 45 degrees of external rotation is an indicator of retroversion
  10. Test for Hip and Sacroiliac Joint
    • •Patrick
    • Test (FABER)

    –Detects pathological conditions of the hip and SI joint

    •Gaenslen’s Test
  11. Testing the Tensor Fasciae Latae and Iliotibial
    • Renne's Test
    • Nobel's Test
    • Ober's Test
    • Trendelenburg's Test
  12. Femoral Fracture
    Signs & Symptoms:

    • •Immediate high levels of pain
    • •Crack or pop
    • •Swelling and discoloration
    • •Cannot bear weight
    • •Hip may be externally rotated and adducted


    • •Immediate stabilization and transport to hospital
    • •Will require surgery to repair the bone
    • •Constant monitoring during rehab to avoid complications
  13. •Femoral Stress Fractures
    • –Etiology
    • •Overuse (10-25% of all stress fractures)
    • •Excessive downhill running or jumping activities
    • •Often seen in endurance athletes

    • –Signs and Symptoms
    • •Persistent pain in thigh/groin
    • •X-ray or bone scan will reveal fracture
    • •Walk with antalgic gait (abduction lurch)
    • •Positive Trendelenburg’s sign

    • –Treatment
    • •Prognosis will vary depending on location
    • •Fx lateral to femoral neck tend to be more complicated
    • •Shaft and medially located fractures tend to heal well with conservative management
  14. Thigh Contusion
    • Signs & Symptoms:
    • •Pain at affected site
    • •Swelling and discoloration
    • •Decreased ROM, especially knee flexion
    • •Difficulty with weight bearing

    • Treatment:
    • •Ice and compression with knee flexion
    • •Progressive strengthening exercises
  15. Quadriceps Strain
    • Signs & Symptoms:
    • •Pain at affected site
    • •Swelling
    • •Decreased ROM, especially knee/hip flexion
    • •Decreased strength
    • •May palpate a divot in muscle

    • •Special Tests:
    • Rectus Femoris Test

    • Treatment:
    • •RICE therapy
    • •Stretching
    • •Progressive strengthening
  16. Myositis Ossificans Traumatica
    • –Etiology
    • •Formation of ectopic bone following repeated blunt trauma (disruption of muscle fibers,
    • capillaries, fibrous connective tissue, and periosteum)
    • •Gradual deposit of calcium and bone formation
    • •May be the result of improper thigh contusion treatment (too aggressive)

    • –Signs and Symptoms
    • •X-ray shows calcium deposit 2-6 weeks following injury
    • •Pain, weakness, swelling, tissue tension and point tenderness w/ decreased ROM

    • –Treatment
    • •Treatment must be conservative
    • •May require surgical removal due to pain and decreased ROM
  17. Hamstring Strain
    • Signs & Symptoms:  
    • •Pain in affected area
    • •Decreased ROM in knee extension
    • •Decreased strength
    • •Swelling
    • •May palpate a divot

    • •Special Tests:
    • 90-90 SLR Test

    • Treatment:
    • •RICE therapy
    • •Stretching
    • •Progressive strengthening
  18. TFLStrain/IT Band Tendinitis
    • Signs & Symptoms:
    • •Pain at affected site
    • •Decreased ROM in abduction/adduction
    • •Tightness

    • Special Tests:
    • •Ober’sTest
    • •Noble Compression Test

    • Treatment:
    • •RICE therapy
    • •Stretching
    • •Progressive strengthening
  19. Hip Dislocation
    • Signs & Symptoms:
    • •Extreme pain
    • •Loss of any ROM
    • •Athlete will be lying with the involved leg slightly flexed, adducted, and internally
    • rotated

    • Treatment:
    • •Immediate stabilization and transport to hospital
    • •Delayed treatment may complicate matters
  20. Hip Pointer
    • Signs & Symptoms:
    • •Extremepain at iliac crest 
    • •Decreased ROM in hip flexion and abduction
    • •Decreased strength
    • •Discoloration

    • Treatment:
    • •Relative rest
    • •Alternate activities such as swimming or biking 
    • •Protective donut pad for activity
  21. Hip Flexor Strain
    • Signs & Symptoms:
    • •Pain at affected site 
    • •Decreased ROM
    • •Decreased strength

    • •Special Tests:
    • Thomas Test

    • Treatment:
    • •RICE therapy
    • •Stretching
    • •Progressive strengthening program
  22. Gluteals Strain
    • Signs & Symptoms:  
    • •Pain at affected site 
    • •Decreased ROM
    • •Decreased strength

    • •Special Tests:
    • Trendelenberg Test

    • Treatment:
    • •RICE Therapy 
    • •Stretching 
    • •Progressive strengthening program
  23. Piriformis Strain
    • Signs & Symptoms:
    • •Pain at affected site 
    • •Tightness in posterior hip
    • •Hip may be externally rotated
    • •Decreased strength

    • •Special Tests:
    • FABER test

    • Treatment:
    • •RICE therapy
    • •Stretching with the FABER test
  24. Groin Strain
    • Signs & Symptoms:  
    • •Pain at affected site
    • •Decreased ROM in adduction
    • •Decreased strength

    • Treatment:
    • •RICE Therapy
    • •Strength and balance training
  25. •Trochanteric Bursitis

    • •Inflammation at the site where the gluteus medius inserts or the IT-band passes over the
    • trochanter

    –Signs and Symptoms

    • •Complaint of lateral hip pain that may radiate down the leg
    • •Palpation reveals tenderness over lateral aspect of greater trochanter
    • •IT-band and TFL tests should be performed


    • •RICE, NSAID’s and analgesics
    • •ROM and PRE directed toward hip abductors and external rotators
    • •Phonophoresis if pain doesn’t respond in 3-4 days
    • •Must look at biomechanics and Q-angle
    • •Runners should avoid  inclined surfaces

  26. •Avascular Necrosis

    •Result of temporary or permanent loss of blood supply to proximal femur

    • •Can be caused by traumatic conditions (hip dislocation – disruption of circumflex
    • artery), or non-traumatic circumstances (steroids, blood coagulation disorders,
    • excessive alcohol use compromising blood vessels)

    –Signs and Symptoms

    •Early stages - possibly no S&S

    •Joint pain w/ weight bearing progressing to pain at times of rest

    •Pain gradually increases (mild to severe) particularly as bone collapse occurs

    •May limit ROM

    •Osteoarthritis may develop

    •Progression of S&S can develop over the course of months to a year
  27. Avascular Necrosis
    • •Management
    • –Must be referred for X-ray, MRI or CT scan

    • –Must work to improve use of joint, stop further damage and ensure survival of bone
    • and joint

    –Most cases will ultimately require surgery to repair joint permanently

    • –Conservative treatment involves ROM exercises to maintain ROM; electric stim for
    • bone growth; non-weight bearing if caught early

    • –Medication to treat pain, reduce fatty substances reacting w/ corticosteroids or limit
    • blood clotting in the presence of clotting disorders  may limit necrosis
  28. •The Snapping Hip Phenomenon

    •Common in young female dancers, gymnasts, hurdlers

    • •Habitual movement predispose muscles around hip to become imbalanced (lateral rotation
    • and flexion)

    • •Related to structurally narrow pelvis, increased hip abduction and limited lateral
    • rotation

    •Hip stability is compromised

    –Signs and Symptoms

    •Pain w/ balancing on one leg, possible inflammation

    • –Treatment
    • •Focus on cryotherapy and
    • ultrasound to stretch musculature and strengthen weak musculature in hip region
  29. •Athletic Pubalgia

    • •Chronic pubic region pain caused by repetitive stress to pubic symphysis from
    • kicking, twisting, or cutting

    • –Forced adduction, from hyperextended position, creates shearing forces that are
    • transmitted through pubic symphysis to insertion of rectus abdominus, hip
    • adductors and conjoined tendon

    • –Result in microtears of tranversalis abdominis fascia, aponeurosis of obliques, or
    • conjoined tightness

    –Create weakening of anterior wall and inguinal canal

    –Signs and Symptoms

    •No presence of hernia

    • •Chronic pain during exertion, sharp and burning that laterally radiates into adductors
    • and testicles
  30. Athletic Pubalgia
    –Signs and Symptoms (continued)

    •Point tenderness on pubic tubercle

    • •Pain increased w/ resisted hip flexion, internal rotation, abdominal contraction,
    • resisted hip adduction (adductors not painful = adductor strain)


    •Conservative treatment (even though rarely effective)

    •Massage, stretching after 1 week of surrounding musculature

    •2 weeks, strengthening of abs and hip flexors and adductors

    •3-4 weeks begin running progression

    •Aggressive treatment involves cortisone injection or tightening of pelvic wall surgically
  31. Sacroiliac Joint Dysfunction
    Signs & Symptoms:  

    •Pain in low back and butt

    •Decreased ROM

    •Pain may increase with activity

    •Possible shooting pain into the thigh

    •Special Tests:

    •Yeoman’s Test

    •Flamingo Test

    •Stork Test


    •RICE therapy

    •Muscle energy techniques

    •Pelvic stabilization
  32. SI Joint Dysfunction

    –Modalities can be used to reduce pain

    –Bracing can be helpful in acute sprains

    –SI joint must be mobilized to correct positioning

    –Strengthening exercises should be used to stabilize the joints
  33. SI Joint Dysfunction Pic
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Card Set:
Thigh, Hip, and Pelvis
2013-11-13 06:22:59
Thigh Hip Pelvis

Thigh, Hip, and Pelvis
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