This document provides an overview of common injuries to the pelvis and thigh, including muscle strains, bursitis, degenerative hip changes, piriformis syndrome, iliac crest contusion, quadriceps contusion, hip dislocation, femur fractures and stress fractures, SI joint dysfunction, osteitis pubis, and avulsion fractures. Muscle strains typically result from eccentric contractions and present with pain at the musculotendinous junction or insertion site. Bursitis can be caused by direct trauma or repetitive friction. Degenerative hip changes develop from repetitive trauma or acute injuries. Piriformis syndrome causes referred pain that may mimic sciatica. Iliac crest contusions are commonly called "

1. KIN 191A Advanced Assessment of Lower Extremity Injuries THE PELVIS AND THIGH INJURIES

2. INTRODUCTION MUSCLE STRAINS BURSITIS DEGENRATIVE HIP CHA N GES PIRIFORMIS SYNDROME ILLIAC CREST CONTUSION QUADRICEPS CONTUSION HIP DISLOCATION FEMUR FRACTURES/STRESS FRACTURES

3. SI JOINT DYSFUNCTION OSTEITIS PUBIS AVULSION FRACTURES (ASIS, AIIS, pubis, ischial tuberosity)

4. MUSCLE STRAINS Typically associated with dynamic overload to eccentric contractions Pain usually felt at musculotendinous junction and/or at insertion site Most involved include quadriceps, hamstrings, hip flexors, adductors

5. BURSITIS Trochanteric Either from direct trauma or repetitive friction from IT band during knee flexion/extension Often referred to as “snapping hip syndrome” Ischial Either from direct trauma or movement in sitting position (rowing, biking, etc.) Iliopsoas Anterior hip pain, difficult to differentiate from hip flexor strain

6. DEGENERATIVE HIP CHANGES Develop secondary to repetitive trauma, age, acute injury Arthritis OCD Avascular necrosis

7. PIRIFORMIS SYNDROME “ Sciatic” nerve proximity to piriformis muscle Spasm or hypertrophy of muscle can produce “sciatica” – referred pain to buttocks or posterior leg May have pain with hip flexion motions Must evaluate sensory and motor function of involved structures

8. ILIAC CREST CONTUSION Commonly referred to as “hip pointer” Attachment site for abdominal, lumbar and pelvic/hip musculature

9. QUADRICEPS CONTUSION Significant bleeding leads to hematoma formation Typically presents with significant loss of ROM to knee flexion Risk of myositis ossificans Must treat appropriately acutely

10. HIP DISLOCATION Posterior more common than anterior Often associated with femoral neck and/or acetabular fractures Classic presentation is adduction and internal rotation Neurovascular considerations

11. FEMUR FRACTURES Involve significant trauma – atypical in athletics Present with immediate loss of function, pain and deformity

13. STRESS FRACTURES Femoral shaft and neck are most common sites Difficult to differentiate from soft tissue injury (strain or tendonitis) Differential diagnosis made via bone scan

14. SI JOINT DYSFUNCTION Collective term for multiple non-specific pathologies If accentuated motions occur at SI joint due to trauma or repetitive stress typically presents with rotation of ilium on sacrum May present as abnormal position due to muscle tightness/weakness or imbalances Must conduct comprehensive neurological evaluation since symptoms often replicate nerve root injury

15. OSTEITIS PUBIS Chronic inflammatory condition at symphysis pubis from repetitive stress to area primarily from running May present with groin pain, pubic symphysis pain and discomfort with abdominal/hip adduction exercises due to muscular attachments Difficult to treat – may need injection

16. AVULSION FRACTURES ASIS – Sartorius AIIS – Rectus femoris Pubis – Adductors Ischial tuberosity – Hamstrings