The Thigh, Hip, Groin, & Pelvis Injuries and Management

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Title: The Thigh, Hip, Groin & Pelvis

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Anatomy of the Pelvis/Thigh/Hip

• Pelvic Girdle Bones:

  • Sacral promontory

  • Transverse process

  • Wing (ala) of ilium

  • Coccyx

  • Sacrum

  • Obturator foramen

  • Pubis (tubercle, arch, symphysis)

  • Iliac crest (including tubercle, anterior superior and inferior iliac spine)

  • Greater and lesser sciatic notch

  • Ischial spine, tuberosity, and inferior pubic ramus

  • Pectineal line, greater trochanter and lesser trochanter of femur

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Ligaments and Structures

• Key Ligaments:

  • Ilium, iliofemoral ligament, pubofemoral ligament

  • Ischial, pubocapsular ligaments

• Femur Components:

  • Greater and lesser trochanters, fovea capitis, neck, and condyles

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Muscles

• Gluteal Muscles:

  • Gluteus maximus, medius, minimus

• Lateral Rotators:

  • Piriformis, superior/inferior gemelli, obturator internus/external

• Locations: Sacrum, coccyx, ischial tuberosity

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Iliopsoas and Adductor Group

• Major Muscles:

  • Iliopsoas (major, iliacus), pectineus, adductors (brevis, longus, magnus), sartorius, gracilis

• Quadriceps Components:

  • Rectus femoris, vastus medialis/lateralis

• Tendon Structures:

  • Quadriceps femoris tendon, patellar ligament

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Range of Motion (ROM)

• Hip Flexion: 0 - 125° (muscles: Quadriceps, Sartorius, Iliacus, Psoas)

• Hip Extension: 115 - 0° (muscles: Hamstrings, Gluteus Maximus)

• Abduction: 0 - 45° (muscles: TFL, Gluteus Medius)

• Adduction: 0 - 20° (muscles: Adductors)

• Rotational Motions:

  • Internal (Gluteus Minimus) and external (Piriformis, Quadratus Femoris) rotation

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Assessment of the Thigh

• History:

  • Onset, previous injuries, mechanism of injury, pain description

• Observation:

  • Postural symmetry, swelling, discoloration, pain clues

• Palpation:

  • Assess tender areas in soft tissue and bony structures

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Prevention of Thigh Injuries

• Strength Training: Essential for endurance and extensibility

• Dynamic Stretching: Helps in muscle preparation and injury prevention

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Recognizing & Management of Thigh Injuries

Quadriceps Contusions

• Cause: Repeated blows to the thigh

• Signs: Pain, temporary loss of function, bleeding

• Early Detection: Vital for faster recovery and minimized scarring

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Contusion Care

• RICE Treatment: Rest, Ice, Compression, Elevation

• Support Measures: Crutches for severe cases, isometric contractions, and preventive treatments like heat, massage, and ultrasound upon return to play

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Myositis Ossificans Traumatica

• Cause: Formation of ectopic bone post-blunt trauma

• Signs: Pain, weakness, decreased ROM

• Care: Conservative treatment, possible surgery if necessary

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Quadriceps Muscle Strain

• Cause: Sudden stretch or contraction

• Signs: Pain, tenderness, possible loss of function

• Care: Rest, ice, compression, neoprene support if needed

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Hamstring Muscle Strain

• Cause: Complex; may involve fatigue or muscle imbalance

• Signs: Localized pain, hemorrhage, loss of function

• Classification: Grade I to III based on severity

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Care for Hamstring Strain

• RICE Treatment: Activity restriction until soreness resolves

• Avoid: Ballistic stretching/sprinting initially

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Recognition and Management of Groin Strain

• Cause: Weakness and lack of flexibility, common at season start

• Signs: Sudden twinge, pain, weakness

• Care: RICE, anti-inflammatory, muscle identification, rest, possible referral

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Groin Strain Continuation

• Care: With wraps for support, if severe refer to physician

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Acute Femoral Fractures

• Cause: Significant force, typically to mid-femur

• Signs: Pain, shock, potential deformity

• Care: Emergency treatment, verify vascular status, splint prior to movement

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Femoral Stress Fractures

• Cause: Common in amenorrheic females

• Signs: Persistent thigh pain, differentiating from quad strain

• Management: RICE, limited weight bearing, pain-free ROM exercises

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Sprains of the Hip Joint

• Cause: Violent twist due to forces

• Signs: Inability to move, hip pain during rotation

• Care: RICE, analysis with imaging for fractures

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Dislocated Hip

• Cause: Rare in sports, from trauma

• Signs: Displaced femoral head posteriorly

• Care: Immediate medical care, avoid complications during immobilization

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Hip Problems in Young Athletes

Legg-Perthes Disease (Coxa Plana)

• Cause: Avascular necrosis in children 4-10 years

• Signs: Pain in groin, limping, variable onset

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Legg-Perthes Disease Continuation

• Care: Bed rest, potentially a brace; early treatment critical to avoid chronic issues

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Slipped Capital Femoral Epiphysis

• Cause: Possibly growth hormone related

• Signs: Gradual pain in groin, reduced motion, limping

• Care: Minor slippage requires rest; severe may need surgery

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Iliac Crest Contusion (Hip Pointer)

• Cause: Direct blow to iliac crest

• Signs: Pain, spasm, reduced movement flexibility

• Care: RICE treatment; monitor severity with imaging if needed

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Osteitis Pubis

• Cause: Repetitive stress in runners

• Signs: Chronic groin pain, tenderness on the pubic region

• Management: Rest, medications, gradual return to activity

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Acute Fracture of Pelvis

• Cause: Blunt trauma

• Signs: Severe pain, loss of function, shock

• Care: Treat for shock, physician referral necessary

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Stress Fractures

• Cause: Overuse; aches during activity

• Care: Referral for assessment, rest required for several weeks

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Avulsion Fractures

• Cause: Sudden acceleration/deceleration

• Signs: Localized pain and limited movement

• Care: Rest, activity limitation, gradual exercise recovery

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Special Tests

• Thomas Test: Tests hip flexor tightness

• Straight Leg Raise: Assesses hip extensor tightness and low back/SI joint dysfunction