Study Notes on Injuries to the Hip and Pelvis

Injuries to the Hip and Pelvis

Major Concepts

  • Overview of anatomy of the hip and pelvis region.
  • Description of common movements and injuries related to hip and pelvis.
  • Importance of coaches recognizing less common injuries due to potential long-term consequences.
  • Discussion of male genitalia injuries, such as testicular contusions and torsion; emphasizes the necessity of proper referral for these cases.
  • Reference to access codes for additional learning activities.

Anatomy Review

  • The hip and pelvis form a "square" structure comprising:
    • Two large, irregular pelvic bones on the lateral sides.
    • Sacrum and coccyx posteriorly.
    • Pubic bones anteriorly.
  • Pelvic bones, also known as innominate bones, consist of:
    • Ilium
    • Ischium
    • Pubis
  • Acetabulum: the junction point where the three pelvic parts fuse, allowing articulation with the femur to form the hip joint.
    • Hip joint: recognized as a true ball-and-socket joint with structural support from strong ligaments.
    • Sacroiliac joints formed by sacral bones and the iliac portions of hip bones.
    • Symphysis pubis formed by the meeting of the two pubic bones.
  • Functions of the bony pelvis include:
    • Attachment for lower extremities.
    • Muscle attachment and protection for pelvic region, significant for females during childbirth (Moore, Dalley, & Aqur, 2013).
  • Nervous and vascular anatomy:
    • Cauda equina: nerve roots that exit the spinal cord at L2 and descend through the pelvis.
    • Important nerves include sciatic nerve (largest in the body, originating from L4-S3) that travels through the pelvis posteriorly down the leg.
  • Muscles associated with movement at the hip include:
    • Medial rotators (e.g., tensor fasciae latae, gluteus minimus).
    • Lateral rotators (e.g., piriformis, gemelli).

Movements of the Hip

  • Movements facilitated by various muscle groups include:
    • Flexors: rectus femoris, iliopsoas, tensor fasciae latae, sartorius.
    • Rectus femoris: attaches to the anterior inferior iliac spine, connecting to the quadriceps via the patellar tendon.
    • Iliopsoas: comprises iliacus and psoas muscles, connecting lumbar spine and iliac crest to the lesser trochanter of femur.
    • Extensors: gluteus maximus, hamstrings (semitendinosus, semimembranosus, biceps femoris).
    • Adductors: pectineus, gracilis, adductors (brevis, longus, magnus).
    • Abductors: gluteus medius and minimus.

Common Sports Injuries

  • Injury Prevalence: Generally, hip and pelvic region injuries are rare. More frequent issues arise with soft tissue injuries, especially in collision sports.
Skeletal Injuries
  • Fractures of the Pelvis:
    • Often caused by significant force, rare in sports participation.
    • Common in hockey, pole-vaulting, football, and occur due to direct compressive forces.
    • Signs and Symptoms of fractures include:
    • Abnormal pain and swelling.
    • Possible visible deformation or tenderness upon palpation.
    • Potential internal organ injury, such as bladder injury (hematuria).
    • Referral for immediate medical evaluation is critical.
Other Adolescent Injuries
  • Stress Fractures
    • Particularly common in amenorrheic runners, usually resulting from muscle fatigue and improper surfaces.
    • Slipped Capital Femoral Epiphysis: occurs typically in 10-15 year old boys, indicated by hip flexion and knee pain.
    • Hip Pointer: contusion to the iliac crest, resulting from a direct blow, often leading to swelling, pain, and functional impairment. Immediate ice and rest are essential.

Soft-Tissue Injuries

  • Avulsion Fractures: occur primarily in skeletally immature athletes, resulting from maximum muscle contraction leading to muscle tearing bone from attachment. Treated with ice, support, and prompt medical evaluation.

Injuries to Male Genitalia

  • Testicular Contusions:
    • Results in extreme pain and temporary loss of mobility post-injury. Risk of rupture is a concern.
    • First Aid: rest, ice application, medical evaluation.
  • Testicular Torsion: requires immediate surgical intervention as it compromises blood supply.
  • Hernias: protrusion of abdominal contents, commonly inguinal or sports hernias in athletes, managed through medical evaluation and potential surgical repair.

Prevention Strategies

  • Conditioning and strength training to mitigate injury risk, such as preventing groin strains, hip pointers, and stress fractures.
  • Importance of using adequate protective equipment and proper footwear to minimize risks associated with specific sports activities.

Review Questions

  1. What type of joint is the hip joint?
  2. Name the bones that make up the hip joint.
  3. Explain the actions of the gluteal muscles.
  4. Outline the location of muscles that cause flexion, extension, adduction, and abduction of the hip.
  5. List bones in the hip area that are susceptible to fracture.
  6. What structures are injured when an athlete suffers a hip pointer?
  7. List symptoms of osteitis pubis.
  8. Explain the difference between testicular contusion and testicular torsion.
  9. Define hernia and outline what a coach should do if one is suspected.
  10. What should be done if an athlete is experiencing pain radiating down the back of the leg?