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Review
Quadriceps
Insertion at proximal patella via common
tendon
Pre-patellar tendon
Rectus femoris = bi-articulate muscle
Only quad muscle that also crosses the hip
Extends knee and flexes the hip
Important: distinguish between knee
extensors and hip flexors
Injury evaluation
Treatment and rehabilitation programs
Hamstrings
Cross the knee joint posteriorly
All hamstrings, except the short of head of the
biceps femoris, are bi-articulate
Crosses the hip joint as well
Forces dependent upon position of both knee and hip
Important: distinguish between knee flexors and hip
extensors
Injury evaluation
Treatment and rehabilitation programs
Thigh Injuries: Quadriceps Contusions
Etiology
MOI = severe impact, direct blow
Extent (depth) of injury depends upon…
Force
Degree of thigh relaxation
Signs and Symptoms
Pain, transitory loss of function,
immediate effusion (palpable)
Graded 1 - 4 = superficial to deep
Increased loss of function 1 - 4
Decreased ROM 1 - 4
Decreased strength 1 - 4
Thigh Injuries: Quadriceps Contusions
Management
RICE
NSAID’s and analgesics
Crutches, if indicated
Aspiration of hematoma
Ice post exercise or re-injury
Follow-up care
ROM exercises
Modalities
Heat
Massage
Ultrasound to prevent
myositis ossificans
Thigh Injuries: Myositis Ossificans Traumatica
Etiology
Formation of ectopic bone
MOI = repeated blunt trauma
May be the result of improper thigh contusion
treatment (too aggressive)
Signs and Symptoms
X-ray shows Ca++ deposit 2 - 6 weeks post injury
Pain, weakness, swelling, tissue tension, point
tenderness, and decreased ROM
Management
Treatment must be conservative
May require surgical removal
Thigh Injuries: Quadriceps Muscle Strain
Etiology
MOI = over-stretching or too forceful contraction
Signs and Symptoms
Pain, point tenderness, spasm, loss of function,
and ecchymosis
Superficial strain results in fewer S&S than
deeper strain
Complete tear results in deformity
Athlete displays little disability and discomfort
Thigh Injuries: Quadriceps Muscle Strain
Management
RICE
NSAID’s and analgesics
Manage swelling
Compression, crutches
Stretching
PRE strengthening exercises
Neoprene sleeve for added support
Thigh Injuries: Hamstring Muscle Strains
Etiology
Fracture in middle third of femoral shaft
MOI = great deal of force
Management
Medical emergency!
Treat for shock, splint, refer
Analgesics and ice
Thigh Injuries: Femoral Stress Fractures
Etiology
Overuse (10-25% of all stress fractures)
MOI = excessive downhill running or jumping
Often seen in endurance athletes
Signs and Symptoms
Persistent pain in thigh/groin region
X-ray or bone scan will reveal fracture
Positive Trendelenburg’s sign
Management
Prognosis will vary depending on location
Fx in shaft and medial to femoral neck heal well with
conservative management
Fx lateral to femoral neck are more complicated
Anatomy of the Hip,
Groin, and Pelvic Region
Review
Functional Anatomy
Hip Joint
True ball and socket joint
Intrinsic stability
Moves in all three planes, particularly during gait
Pelvis
Moves in all three planes
Anterior tilting
Changes degree of lumbar lordosis
Lateral tilting
Changes degree of hip abduction
Assessment of the Hip and Pelvis
Injuries to the hip or pelvis cause major
disability in the lower limbs, trunk, or both
Low back may also become involved
History
Onset (sudden or slow?)
Previous history?
Mechanism of injury?
Pain description, intensity, quality, duration,
type, and location?
Assessment of the Hip and Pelvis
Observation
Symmetry - hips, pelvis tilt (anterior/posterior)
Lordosis or flat back
Lower limb alignment
Knees, patella, feet
Pelvic landmarks
ASIS, PSIS, iliac crest
Standing on one leg
Pubic symphysis pain or drop to one side
Ambulation
Special Tests: Leg Length Discrepancy
True or anatomical
Shortening may be equal throughout limb or
localized in femur or lower leg
Measure from ASIS to medial malleolus
Apparent or functional
May result due to lateral pelvic tilt, flexion, or
adduction deformity
Measure from umbilicus to medial malleolus
Leg Length Discrepancy Measures
Hip and Groin Injuries
Groin Strain
Etiology
Injury usually occurs to the adductor longus
MOI = running, jumping, or twisting with hip
external rotation; over-stretching; or too
forceful contraction
Signs and Symptoms
Sudden twinge or tearing during movement
Pain, weakness, and internal hemorrhaging
Hip and Groin Injuries
Groin Strain (continued)
Management
RICE
NSAID’s and analgesics
Rest is critical
Modalities
Daily whirlpool and cryotherapy
Ultrasound
Delay exercise until pain free
Restore normal ROM and strength
Provide support with elastic wrap
Hip and Groin Injuries
Trochanteric Bursitis
Etiology
Inflammation of bursa at greater trochanter
Insertion site for gluteus medius and where IT-band
passes over the greater trochanter
Signs and Symptoms
Lateral hip pain that may radiate down the leg
Point tenderness over greater trochanter
IT-band and TFL tests should be performed
Hip and Groin Injuries
Trochanteric Bursitis (continued
Management
RICE
NSAID’s and analgesics
ROM and PRE exercises for hip abductors
and external rotators
Phonophoresis
Evaluate biomechanics and Q-angle
Runners should avoid inclined surfaces
Hip and Groin Injuries
Sprains of the Hip Joint
Etiology
Unusual movement exceeding normal ROM
MOI = force from opponent/object, or, trunk
forced over planted foot in opposite direction
Signs and Symptoms
Pain, which increases with hip rotation
Inability to circumduct hip
Similar S&S to stress fracture
Hip and Groin Injuries