Injuries to Pelvis and Hip

Anatomy of Pelvis
• Bones of pelvic • Articulations of
girdle pelvic girdle
1. ilium 1. sacroiliac joint
2. ischium 2. pubis symphysis
3. pubis
4. sacrum
** ilium, ischium, and
pubis combined
form the 2 pelvic
bones
Pelvic Girdle
• Anatomy Of The
Pelvis
 Major Muscles of Pelvis
1. Hip Flexion 3. Adduction
• Iliopsoas • adductor longus
– Iliacus • adductor magnus
– Psoas Major • adductor brevis
• sartorius • gracilis
• quadricep muscles • pectineus

2. Abduction 4. Hip Extension

• gluteus medius • hamstrings
• gluteus minimus • gluteus maximus
• tensor fasciae latae
 Muscles of the Pelvic and Hip
• Muscles of the Pelvic
and Hip
 Identification
• Identify the following:
– Illium
– Ischium
– Pubis
– Sacrum
– Sacroiliac joint
– Pubis symphasis
– Iliac crest
 Identification
• Identify the following:
– Psoas Major
– Iliacus
– Tensor Fasciae Latae
– Adductor Magnus
– Adductor Brevis
– Adductor Longus
– Gracilias
– Pectineus
– Piriformis
 Identification

• Identify the following:

– Gluteus Maximus
– Gluteus Minimus
– Gluteus Medius
Blood Supply to Lower Extremities
• Arteries • Veins
– Iliac – iliac
– femoral – femoral
– popliteal – saphenous
– tibial – popliteal
– peroneal – tibial
– peroneal
 Blood Supply to Pelvis
• Pelvic Blood Supply
– Iliac artery
• Internal
• External
 Injuries to Pelvic Region
• Fractures in Pelvic Region
• Very rare in sports
• Most common
1. stress
2. avulsion
• Symptoms
1. altered gait
2. localized pain
 Stress Fractures
• Stress Fx
– Small crack in bone
– Overuse injury
– Uncommon in pelvic
area (1 to 7% of
reported stress fx)
– Seen mainly in
distance runners
– More common in
females
 Stress Fractures
• Stress Fx
– Symptoms
• Chronic pain in pelvis
area
• Gets worse with activity
– Diagnosis
• X-rays and bone scans
– Treatment
• Rest / no activity
• Some may need
crutches for few days
Stress Fracture
 Avulsion Fracture
• Avulsion Fx
– Piece of bone pulls away at
tendon attachment site
– Caused when muscle
contracts too rapidly or
quickly (sudden stops,
starts or jumping)
– Symptoms
• May hear or feel a “pop”
• Immediate pain
• Decreased ROM
• Limping
 Avulsion Fractures
• Avulsion Fracture
– Treatment
• 4 to 6 weeks of rest
• Physical Therapy
– Incidences
• Rare but seen in sports
that require sprinting or
rapid changes in
movement
• Basketball, track and
soccer
 Avulsion Fractures
• Can occur at
many points
along pelvis
– Iliac crest
– Anterior superior
iliac spine (ASIS)
– Anterior inferior
iliac spine (AIIS)
– Ischial tuberosity
– Pubic symphysis
Common Avulsion Fracture
Sites
• Avulsion fx of left • Avulsion fx of anterior
ischium superior iliac spine
Avulsion Fracture
 Hip Pointers
• Hip Pointers
– Blow to the iliac crest
– Causes bone bruise
– Symptoms
• Point tenderness along
iliac crest/spine
• Loss of ROM
– Treatment
• Rest
• Ice
• ROM exercises
• Donut shaped padding
Hip Pointers
Hip Pointers
 Injuries to Pelvic Region
• Strains (Adductors or Hip Flexors)
– Mechanism of Injury
1. extreme rotation
2. excessive abduction
– Treatment
1. ice
2. stretch
3. leg strengthening
 Anatomy of Hip and Thigh
• Bones
1. Femur
2. Pelvic bone

• Articulations (Hip Joint)

1. Head of femur
2. Acetabulum of pelvis
bone
** ball and socket joint
 Bony Landmarks of Hip
• Hip Joint
– Acetabulum
• “socket” for hip joint
– Femoral Head
• “ball” for hip joint
– Greater trochanter
– Lesser trochanter
– Femoral neck
– Femur
 ROMS of Hip Joint
• Flexion
• Extension
• Abduction
• Adduction
• Medial Rotation
• Lateral Rotation
 Major Muscles of Hip
• Hip flexion & Knee extension
– Anterior thigh muscles
• Quadriceps Group
– rectus femoris,
– vastus medialus,
– vastus lateralis,
– vastus intermedius
 Major Muscles of Hip
• Hip extension & Knee flexion
– Posterior thigh muscles
• Hamstring Group –
– Semitendinosus
– Semimembranosus
– Biceps femoris
 Injuries to the Hip and Thigh
• Fractures of Femur
– Great force required to break femur
– Contact sports, BMX, skateboarding,
motorcross increase risk
– Splint, send to physician, or call EMS
Femur Fracture
Femoral Neck Fracture Repair
 Injuries to the Hip and Thigh
• Subluxation / Dislocation
– Symptoms
1. complete loss of function
2. severe pain
3. deformity

– Mechanism of Injury
1. direct blow
2. twisting force
Dislocated Hip
Subluxation of the hip
 Injuries to the Hip and Thigh
• Contusions
– “Charley Horse” = bruise to the quad muscles

– Mechanism of Injury
• Direct blow to thigh causing bleeding in the muscle
tissue

– Treatment
1. ICE
2. keep knee flexed while applying ice
3. mild stretching through pain free ROM
** if stretching is not done, blood will pool and leave
area vulnerable to myositis ossificans
 Injuries to the Hip and Thigh
• Sprains
– Mechanism of injury
1. sudden jerking or twisting motions
2. more frequent in non or poor conditioned athletes

– Treatment
• PRICE
• Stretching & ROM exercises
• If injury doesn’t improve within 3 days, send to
physician
 Injuries to the Hip and Thigh
• Strains
– Most common = hamstrings, hip flexor,
adductors and quad

– Treatment
• ICE
• Stretching
• Strengthening
 Injuries to the Hip and Thigh
• Bursitis / Synovitis
– Most common is inflammation of the trochanter bursa

– Mechanism of Injury
1. direct blow
2. repeated stress

– Symptoms
1. slight swelling
2. persistent ache

– Treatment
1. rest
2. stretching
Special Tests for Hip and Pelvis
• Thomas Test – hip flexor flexibility

Negative

Positive
Iliotibial (IT) Band
Special Tests for Hip and Pelvis
• Ober’s Test – Iliotibial (IT) band flexibility
Stretches for IT Band
Special Tests for Hip and Pelvis
• Patrick’s or Faber Test – deformity or
weakness of the iliopsoas muscle and
sacroiliac pain
Special Tests for Hip and Pelvis
• Trendelenburg Test – hip abductor
weakness