Successfully reported this slideshow.

Kin191 A.Ch.8. Pelvis. Thigh. Injuries

1,858 views

Published on

  • Be the first to comment

Kin191 A.Ch.8. Pelvis. Thigh. Injuries

  1. 1. KIN 191A Advanced Assessment of Lower Extremity Injuries THE PELVIS AND THIGH INJURIES
  2. 2. INTRODUCTION <ul><li>MUSCLE STRAINS </li></ul><ul><li>BURSITIS </li></ul><ul><li>DEGENRATIVE HIP CHA N GES </li></ul><ul><li>PIRIFORMIS SYNDROME </li></ul><ul><li>ILLIAC CREST CONTUSION </li></ul><ul><li>QUADRICEPS CONTUSION </li></ul><ul><li>HIP DISLOCATION </li></ul><ul><li>FEMUR FRACTURES/STRESS FRACTURES </li></ul>
  3. 3. <ul><li>SI JOINT DYSFUNCTION </li></ul><ul><li>OSTEITIS PUBIS </li></ul><ul><li>AVULSION FRACTURES (ASIS, AIIS, pubis, ischial tuberosity) </li></ul>
  4. 4. MUSCLE STRAINS <ul><li>Typically associated with dynamic overload to eccentric contractions </li></ul><ul><li>Pain usually felt at musculotendinous junction and/or at insertion site </li></ul><ul><li>Most involved include quadriceps, hamstrings, hip flexors, adductors </li></ul>
  5. 5. BURSITIS <ul><li>Trochanteric </li></ul><ul><ul><li>Either from direct trauma or repetitive friction from IT band during knee flexion/extension </li></ul></ul><ul><ul><li>Often referred to as “snapping hip syndrome” </li></ul></ul><ul><li>Ischial </li></ul><ul><ul><li>Either from direct trauma or movement in sitting position (rowing, biking, etc.) </li></ul></ul><ul><li>Iliopsoas </li></ul><ul><ul><li>Anterior hip pain, difficult to differentiate from hip flexor strain </li></ul></ul>
  6. 6. DEGENERATIVE HIP CHANGES <ul><li>Develop secondary to repetitive trauma, age, acute injury </li></ul><ul><ul><li>Arthritis </li></ul></ul><ul><ul><li>OCD </li></ul></ul><ul><ul><li>Avascular necrosis </li></ul></ul>
  7. 7. PIRIFORMIS SYNDROME <ul><li>“ Sciatic” nerve proximity to piriformis muscle </li></ul><ul><li>Spasm or hypertrophy of muscle can produce “sciatica” – referred pain to buttocks or posterior leg </li></ul><ul><li>May have pain with hip flexion motions </li></ul><ul><li>Must evaluate sensory and motor function of involved structures </li></ul>
  8. 8. ILIAC CREST CONTUSION <ul><li>Commonly referred to as “hip pointer” </li></ul><ul><li>Attachment site for abdominal, lumbar and pelvic/hip musculature </li></ul>
  9. 9. QUADRICEPS CONTUSION <ul><li>Significant bleeding leads to hematoma formation </li></ul><ul><li>Typically presents with significant loss of ROM to knee flexion </li></ul><ul><li>Risk of myositis ossificans </li></ul><ul><li>Must treat appropriately acutely </li></ul>
  10. 10. HIP DISLOCATION <ul><li>Posterior more common than anterior </li></ul><ul><li>Often associated with femoral neck and/or acetabular fractures </li></ul><ul><li>Classic presentation is adduction and internal rotation </li></ul><ul><li>Neurovascular considerations </li></ul>
  11. 11. FEMUR FRACTURES <ul><li>Involve significant trauma – atypical in athletics </li></ul><ul><li>Present with immediate loss of function, pain and deformity </li></ul>
  12. 12.
  13. 13. STRESS FRACTURES <ul><li>Femoral shaft and neck are most common sites </li></ul><ul><li>Difficult to differentiate from soft tissue injury (strain or tendonitis) </li></ul><ul><li>Differential diagnosis made via bone scan </li></ul>
  14. 14. SI JOINT DYSFUNCTION <ul><li>Collective term for multiple non-specific pathologies </li></ul><ul><li>If accentuated motions occur at SI joint due to trauma or repetitive stress typically presents with rotation of ilium on sacrum </li></ul><ul><li>May present as abnormal position due to muscle tightness/weakness or imbalances </li></ul><ul><li>Must conduct comprehensive neurological evaluation since symptoms often replicate nerve root injury </li></ul>
  15. 15. OSTEITIS PUBIS <ul><li>Chronic inflammatory condition at symphysis pubis from repetitive stress to area primarily from running </li></ul><ul><li>May present with groin pain, pubic symphysis pain and discomfort with abdominal/hip adduction exercises due to muscular attachments </li></ul><ul><li>Difficult to treat – may need injection </li></ul>
  16. 16. AVULSION FRACTURES <ul><li>ASIS – Sartorius </li></ul><ul><li>AIIS – Rectus femoris </li></ul><ul><li>Pubis – Adductors </li></ul><ul><li>Ischial tuberosity – Hamstrings </li></ul>

×