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![Page 1: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/1.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
The Thigh, Hip, Groin, and Pelvis
PE 236Amber Giacomazzi, MS, ATC
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 2: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/2.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 3: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/3.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 4: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/4.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 5: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/5.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 6: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/6.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 7: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/7.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 8: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/8.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 9: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/9.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
Prevention of Thigh Injuries
• Thigh must have ____________, ___________, and ________ to withstand _______
• ____________________ may aid in muscle preparation for activity
• _____________ can also help in preventing injuries– ____________________– ____________________
![Page 10: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/10.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
Recognition and Management of Thigh Injuries
• Quadriceps Contusions– Cause of Injury
• Constantly exposed to _______________
– Signs and Symptoms• Pain, ______________, ______________ of affected
muscles• ___________ and ________________ are vital –
increases ____________ and prevents _____________
![Page 11: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/11.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Treatment– _________________– Crutches for more
severe cases– Isometric quadriceps
contractions should begin as soon as tolerated
– _________________ _________________ _________________
– Padding may be worn for additional protection upon return to play
![Page 12: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/12.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Myositis Ossificans– Cause of Injury
• _________________________________________ _______________
– Signs and Symptoms• X-ray shows ___________________ following
injury• Pain, weakness, swelling, decreased ROM• _____________ and __________________
– Treatment• Treatment must be _______________• May require __________________ and _______
_____ (after one year - remove too early and it may come back)
• If condition is recurrent it may indicate problem with ___________
![Page 13: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/13.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 14: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/14.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Quadriceps Strain– Cause of Injury
• ____________ when athlete falls on _______ or experiences _______________
• Associated with _________________________________
– Signs and Symptoms• ___________ causes fewer symptoms than ___________• Pain, point tenderness, spasm, loss of function and little
discoloration• ____________ may leave athlete w/ little _________ and
____________ but with some ____________
– Treatment• Rest, ice and compression to control internal bleeding• ________________________ • Neoprene sleeve may provide some added support
![Page 15: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/15.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Hamstring Strains– Cause of Injury
• Multiple theories of injury– ________________________________– Change in role from ________________________– _________________________________________
_________________________________________
– Signs and Symptoms• __________________________________• Capillary hemorrhage, pain, ______________ and
_________________________– Grade 1 - __________________ and point tenderness – Grade 2 - ___________________________________
___________________________________________
![Page 16: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/16.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
– Signs of Injury (continued)– Grade 3 - __________ of tendinous or muscular tissue,
involving _________________ , ______ , loss of function, _________, __________________
– Treatment• RICE • ____________ until soreness has subsided• ______________ and ______________ should be
avoided initially
![Page 17: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/17.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Acute Femoral Fractures– Cause of Injury
• Generally involving shaft and requiring great force• Occurs in ___________ due to _______and
________________– Signs and Symptoms
• Shock, pain, swelling, deformity– Must be aware of ______________ and ______________
• ___________________– Treatment
• Treat for shock, ______________, ____________ _______ , reduce following X-ray
• Secure immediate emergency assistance and medical referral
![Page 18: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/18.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Femoral Stress Fractures– Cause of Injury
• __________• Females who are ___________ are more vulnerable
to stress fx– Signs and Symptoms
• ____________________• X-ray or _________ will reveal fracture• Commonly seen in ______________
– Treatment• __________________________• ROM and PRE exercises are carried out w/ pain free
ROM• ______, ________________
![Page 19: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/19.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
Recognition and Management of Specific Hip, Groin, and Pelvic
Injuries• Groin Strain
– Cause of Injury • One of the more difficult problems to diagnose• Often seen in ____________ due to __________ and
________________• Occurs from running , jumping, twisting w/ hip
___________ or ____________
– Signs and Symptoms• Sudden twinge or tearing during active movement• Produce _____ , ________, and __________________
![Page 20: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/20.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Groin Strain (continued)– Treatment
• RICE, NSAID’s and analgesics for ___________• Determine _________ or _______________• ______________• Restore normal _____ and ________ -- ________
________________• Refer to physician if severe groin pain is
experienced
![Page 21: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/21.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Sprains of the Hip Joint– Cause of Injury
• Result of ___________ due to ______________• Force from opponent/object or ______________
____________________________
– Signs and Symptoms• Signs of acute injury is the inability to __________ hip• Pain in hip region, w/ hip rotation ________________
– Treatment• X-rays or MRI should be performed to rule out fx• RICE, NSAID’s and analgesics• Depending on severity, ___________________• _______ and _____ are delayed until hip is pain free
![Page 22: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/22.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Piriformis Syndrome– Cause of Condition
• Compression of __________; irritation due to ________ or ______ of muscle
• May mimic ___________
– Signs and Symptoms• Pain, __________ and ___________– may extend ________ and
__________• Pain may increase following periods of _______, ___________,
walking or running
– Treatment• _____________________• NSAID’s may be prescribed• __________________________ will be prescribed• Corticosteroid injection may also be suggested• Surgery is sometimes an option as well
![Page 23: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/23.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Dislocated Hip– Cause of Injury
• ________________________• Result of traumatic force directed along the long axis of the femur
– Signs and Symptoms• ___________________________________• Palpation reveals displaced femoral head, _______________• Serious pathology
– _____________________________________
– Treatment• Immediate medical care (__________________ may be
compromised)• Prepare for shock• 2 weeks immobilization and crutch use for at least one month
![Page 24: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/24.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
Hip Problems in Adolescent Athletes
• Legg Calve’-Perthes Disease (Coxa Plana)– Cause of Condition
• ________________ of the femoral head in child ages 4-10• Articular cartilage becomes ____________________
– Signs and Symptoms• Pain in ______that can be referred to the abdomen or knee• ___________________• Varying onsets and may exhibit _______________
![Page 25: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/25.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 26: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/26.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
•Legg-Calve’-Perthes Disease
– Treatment• Bed rest to reduce chance of chronic condition• ___________________________• Early treatment and ______________________
_______________
– Complication• If not treated early, will result in ill-shaping and
________________ in later life
![Page 27: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/27.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Slipped Capital Femoral Epiphysis
– Cause of Condition• Epiphysis slips from femoral head in _______________ due to
weakness in _______________• May occur during periods of elevated growth
– Signs and Symptoms• Pain in _________ that comes on over weeks or months• Hip and knee pain during ________ and ________ motion;
limitations of _________, ________, ____________ and a limp
– Treatment• W/ minor slippage, ________________________________
____________________• Major displacement requires surgery• If undetected or surgery fails severe problems will result
![Page 28: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/28.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 29: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/29.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Iliac Crest Contusion (hip pointer)– Cause of Injury
• Contusion of ________ or _______________• Result of direct blow
– Signs of Injury• Pain, spasm, and transitory paralysis of soft structures• __________________ or _________________ due to pain
– Care• ______________________________• Bed rest 1-2 days in severe cases• Referral must be made, X-ray• ____________ should be used upon return to minimize chance
of added injury
Recognition and Management of Injuries to the Pelvis
![Page 30: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/30.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
![Page 31: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/31.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Osteitis Pubis– Cause of Injury
• Seen in ______________• Repetitive stress on ______________ and _______
___________
– Signs and Symptoms• Chronic pain and inflammation of groin• _______________________• Pain w/ __________, ______________
– Treatment• Rest, NSAID’s and gradual return
to activity
![Page 32: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/32.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Acute Fracture of Pelvis– Cause of Injury
• Result of ________________________
– Signs and Symptoms • Severe pain, loss of function, shock
– Treatment• ______________________• Refer to physician• Seriousness of injury dependent on
______________ and ______________________
![Page 33: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/33.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Stress Fractures– Cause of injury
• Repetitive abnormal overused forces – Signs and Symptoms
• ______________________________________ ______________________________________
• Discomfort increases with activity and subsides during rest
– Treatment• Refer to physician for assessment and X-ray• Rest for _________________
![Page 34: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/34.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Avulsion Fractures– Cause of Injury
• Avulsions seen in sports w/ sudden accelerations and decelerations
• Pulling of tendon away and off of bony insertion• Common sites include ____________, _________
_________________, ____________________– Signs and Symptoms
• Sudden localized pain w/ limited movement• Pain, swelling, point tenderness
– Treatment• ________________________________________
![Page 35: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/35.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
Assessment of the Thigh• History
– Mechanism of injury?
• Observation– ____________________– ____________________________– _____________________
![Page 36: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/36.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Palpation– Soft tissue of the thigh (anterior, posterior,
medial, lateral) should be palpated for pain and tenderness
– Bony palpation should also be performed to locate areas of pain/discomfort
– Utilize palpation to assess body symmetry
![Page 37: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/37.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Special Tests– ______________
• Test for hip contractures
– ______________• Test for hip
extensor tightness• Can also be used to
assess __________ ________________
![Page 38: © 2007 McGraw-Hill Higher Education. All rights reserved. The Thigh, Hip, Groin, and Pelvis PE 236 Amber Giacomazzi, MS, ATC © 2007 McGraw-Hill Higher.](https://reader035.fdocuments.in/reader035/viewer/2022070411/56649cce5503460f9499a1ca/html5/thumbnails/38.jpg)
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Special Tests– ________________
______• Test for weakness in
the gluteus medius muscle on the ___________
– _____________• Test for ITB
tightness