The Pelvis Hip Thigh Injuries of the Athlete

The Pelvis, Hip and Thigh

Introduction
Biomechanics
Contusion of Quadriceps
Myositis Ossificans Traumtica
Quadriceps Strain and Ruptures
Avulsions of the Ilia... (More) The Pelvis, Hip and Thigh

Introduction
Biomechanics
Contusion of Quadriceps
Myositis Ossificans Traumtica
Quadriceps Strain and Ruptures
Avulsions of the Iliac Spines
Hamstring Strains
Ischial Apophysitis
Groin Strains
Hip Pointer and Fracture Iliac Crest
Iliac Crest Apophysitis and Avulsion
Trochanteric Bursitis and Snapping Hip
Hip Strain and Conjoint Tendon Strain
Osteitis Pubis
Nerve Entrapment
Labral tears
Stress fractures
Fractures
Dislocations
Hip Arthroscopy
Avascular Necrosis Femoral Head
Osteoarthritis
Introduction

Injuries of the hip, thigh and pelvis are common.

The hip is poorly designed, we stand on the end of a lever ( NOF, neck of femur). So BW is magnified about the anatomical axis of the leg; it is no wonder that the NOF breaks so easily and often(meaning until recently, the end of life from mechanical failure of the musculoskeletal system).

Apart from fractures, such injuries cam be subtle and difficult to diagnose. Especially before the advent of widespread MRI scanning.

Careful examination and investigation will help (possibly arthroscopy).

Contusions, strains, tears and avulsion fractures may form a continuum of injuries to this region. The more obvious fractures and dislocations may be limb or life threatening.

1

Biomechanics of the Hip

The hip is a ball and socket joint with simultaneous motion in all 3 planes (up to 120° of flexion, 20° of abduction and 20° of external rotation). The joint reactive forces are 3 to 6 times body weight due to contraction of the large muscle groups about it.

The acetabulum has a fibrocartilaginous rim (labrum) to deepen it and so add further stability. Its floor is almost paper thin. The postero-superior surface of the acetabulum is thickest to accommodate weight-bearing. The neck forms an angle of about 125° with the shaft and is 20° anteverted. The hip capsule drops down across the front of the neck but only part-way at the back. It is reinforced by three ligaments (the ilio-femoral ligament of Bigelow is the strongest). The major blood supply to the head is from the medial circumflex branch (of the profunda femoris) which is at risk from fractures of the neck of femur and dislocations.

Contusion of Quadriceps (cork thigh, Charley Horse)

Contusion is the general result of a direct blow during contact sports and varies from mild to severe. They are often worse when the muscle is relaxed. The injury commonly occurs in the musculotendinous junction of the rectus femoris (Fig.1).

Clinical features. There is pain, stiffness, a limp, and progressive swelling and bruising. The pain is exacerbated by resisted knee extension and hip flexion. Due to bleeding in the soft tissues the pain and limitation of movement often becomes worse over the subsequent 48 hours.

DO NOT DO AN MRI WHICH WILL ONLY CONFUSE THE ISSUE. X RAYS AND A CLEAR HX OF INJURY ARE SUFFICIENT.

These injuries can be classified according to that of Jackson and Fagin (1973) (Fig. 2).

Figure 2

Classification of Contusions

Mild

Moderate

Severe

Characterised by localised tenderness in the quadriceps, knee motion of 90 degrees or more, non alteration of gait. The athlete is able to do a deep knee bend.

Characterised by swollen tender muscle mass, less than 90 degrees of knee motion and antalgic gait. The athlete is able to do knee bends, climb stairs, or arise from a chair without pain.

Thigh is markedly tender and swollen and the contours of the muscle cannot be defined by palpation. Knee motion is less than 45 degrees and there is a severe limp. The athlete prefers to walk with crutches and frequently has an effusion in the ipsilateral knee.

Treatment

Jackson and Fagin initially described three phas (Less)

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