Chapter 21: The Thigh, Hip, Groin, and Pelvis

Anatomy of the Thigh

Femur

Is the strongest bone and the largest bone in the body.

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

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

Important to distinguish between hip flexors relative to injury for both treatment and rehab programs

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

Special Tests

Recognition and Management of Thigh Injuries

Quadriceps Contusions: Most common thigh injury

Etiology

Constantly exposed to traumatic blunt blow

Contusions usually develop as a result of severe impact

Extent of force and degree of thigh relaxation determine depth and functional disruption that occurs

Signs and Symptoms

Pain, transitory loss of function, immediate effusion with palpable swollen area

Graded 1-4 = superficial to deep with increasing loss of function (decreased ROM, strength)

Quad Contusion

Management

RICE, NSAIDπs and analgesics

Heat, massage and ultrasound to prevent myositis ossificans

General rehab should be conservative

Quadriceps Muscle Strain

Hamstring Muscle Strains

(second most common thigh injury)

Hamstring Muscle Strain (Second Most Common

Acute Femoral Fractures

Femoral Stress Fractures

Anatomy of the Hip, Groin and Pelvic Region

Outward Rotators

Functional Anatomy

Anterior tilting changes degree of lumbar lordosis, lateral tilting changes degree of hip

Pelvis: supports the spine and trunk and transfers weight to the lower limbs.

Assessment of the Hip and Pelvis

Observation

Special Tests

Tests for Hip Flexor Tightness

Kendall test

Test for rectus femoris tightness

Thomas test

Test for hip contractures

Femoral Anteversion (A) and Retroversion (B)

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

Test for Hip and Sacroiliac Joint

Patrick Test (FABER)

Gaenslenπs Test

Renneπs test

Athlete stands w/ knee bent at 30-40 degrees

Positive response of TFL tightness occurs when pain is felt at lateral femoral condyle

Nobelπs Test

Oberπs Test

Test is positive when affected side is higher indicating weak abductors (glut medius)

Piriformis Test

Elyπs Test

limbs, hips, pelvis or low back

Injuries

Groin Strain

Trochanteric Bursitis

Sprains of the Hip Joint

Dislocated Hip

Avascular Necrosis

Contusion (hip pointer)

Hip Pointer

Stress Fractures

Avulsion Fractures and Apophysitis

General Body Conditioning

Must maintain cardiovascular fitness, muscle endurance and strength of total body

Avoid weight bearing activities if painful

Flexibility

Regaining pain free ROM is a primary concern

Progress from passive to PNF stretching

Mobilization

Will be necessary if injury and subsequent limitation is caused by tightness of ligaments and capsule surrounding the joint

Neuromuscular Control