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21 Cards in this Set
- Front
- Back
Anatomy |
Femur - head with fovea capitis and neck, greater trochanter. Hips - Ilium, ishcium, pubis. Ligaments between both: iliofemoral, pubofemoral, ischiofemoral. Muscles: Glute max, hanstrings, iliopsoas(usually too tight), rectus femorus (crosses 2 joints) Piriformis - sciatic nerve exits underneath and can bind on the nerve. Nerves: Sciatic (Posterior thigh), femoral (anterior thigh), oburator (adductors) Veins/arteries: External iliac a., femoral a., great sapenous vein, femoral vein. 3 compartments - 1 anterior 2 posterior. |
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Functional anatomy of the thigh |
- Quads insert via common tendon above patella - rectus femoris only quad that crosses the hip and knee - Hamstrings cross knee joint posteriorly except short head of biceps crosses the hip. |
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Functional anatomy of hip and pelvis |
Pelvis has 3 planes of mvmt Hip is true ball and socket / stable Hip moves in all 3 planes eg in gait. Large forces occur here. Muscles most commonly injured in this region. Many attachments here = hard to distinguish problem. |
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Injury prevention |
protective equipment - thigh pads, girdles, cups, braces, sleeves. Physical conditioning - strength, endurance, flexibility. Shoes - cushion forces. |
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Potential injuries |
Acute: Contusions, myositis ossificans, strains (quads, hams, glutes, groin, hip flexor), sprains (hip), fractures (femoral), hip dislocations Chronic/overuse: Trochanteric bursitis, femoral stress fracture. |
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Quad contusions |
E: Blunt trauma, muscular compression, extent of force and thigh relaxation = determinants. S&S: Swelling, pain, bleeding, temp loss of function, weakness. Graded 1-4, superficial to deep. M: RICE, knee flexion, crutches, therapy for pain. ROM and stretching, protect RTP, no massage or heat initially. |
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Grades of contusions |
1: Little/no pain, mild hemorrhaging, no swelling, milk pt. tenderness, no disability. 2: Mild pain, swelling, (moderate) hemorrhaging, pt. tenderness, disability (less than 90 degree knee flex), limping. 3: Moderate pain, swelling, disability (greater than 45 but less than 90 degrees knee flex), limping. 4: Severe pain, swelling, disability (less than 45 degrees knee flex), muscle herniation (potentially), obv. limp unable to WB. |
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Hip contusions |
Hip pointer E: Direct blow to iliac crest or abdominal musculature. S&S: Pain, spasm, swelling, transitory paralysis of soft structures, decreased rotation of trunk or thigh/hip flex. M: RICE for 48hrs, ice massage, protection w/ RTP, rule out fracture. |
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Myositis ossificans |
E: Form of ectopic bone following direct blow, repeated blunt trauma, improper care of thigh contusion. S&S: Pain, weakness, swelling, pt tenderness, decreased ROM/function. X rays show deposits 2-6wks following. M: Conservatively, physician referral. Compression shorts? |
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Trochanteric Bursitis |
E: Inflammation glute med insertion wher ITB passes over trochanter = direct trauma. S&S: Pt tenderness over lateral greater trochanter, lateral hip possibly radiating down leg. Pain straight down. M:NSAIDS, RICE, ROM pf hip abductors and ext rotators. Look at Q angle, inclined surface avoidance. |
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Grades of strains |
1: Limited swelling, tightness. Near normal gait, mild pt tenderness/discomfort during palpitaiton. Soreness during mvmt, <20% fibers torn. 2: Pain and swelling w/ palpitation, palpable divot maybe, pain w/ resisted muscle testing, limping, muscle spasm, <70% fibers torn. 3: Rupturing tendinous or muscular tissue. Major hemorrhage and edema, major disability and loss of function, pain and palapble defect or mass. >70% fibers torn. |
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Quad strain |
E: Sudden stretch, violent forceful contraction of hip and knee into flexion. S&S: Pain, spasm, swelling, delayed bruising, loss of function, loss of ROM and strength or extensors. M: RICE, crutches, wrap, later use of sleeve, slow ROM progressions, stretching, isometrics, 12wks RTP. |
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Hip flexor strain |
E: Sudden overstretch into hyperextension. S&S: Pain, swelling, delayed bruising and disability, decreased ROM and extensor strength. M: RICE, crutches, hip spica wrap. |
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Hamstring strain |
E: Overlfexing hip, sudden explosive contraction/ acceletation. Fatigue, posture, leg lenght imbalances. S&S: Pain, swelling, delayed bruising, spasm, disability, decreased ROM and extensor strength. M: RICE, crutches, wrap, conservative treatment w/ gradual ROM/strengthening. |
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Adductor strain |
E: Overstretch into abduction, ER and hip extension. S&S sudden twinge or tearing pain, swelling, delayed bruising, decreased ROM and strength. M: RICE, rest is key, spica hip wrap. |
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Hip sprain |
E: Violent twisting with or without impact, forceful contraction, or trunk forced over planted foot in opposite direction. S&S: Hip pain, increases with rotational movement. M: xrays, RICE, crutches, delay ROM/Strengthening till pain free. |
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Hip dislocation |
E: Traumatic force along long axis of femur (posterior dislocation w/hip flexed &knee flexed.) S&S: flexed adducted internally rotated hip. Deformity, pain, muscular spasm, neurological issues, possible fracture. Will look longer than the other leg! M: 911, immediate care as neurovascular supply may be damaged. 2 wks immobilization and crutch for 1 month. |
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Femoral fracture
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E: Lots of force, fall from height, direct blow. MVA? S&S: pain, swelling, deformity (shorter), muscle guarding, hip adducted and externally rotated.
M: 911 call, treat for shock, nerovascular supply checks, vitals, splint, analgesics and ice, surgery and immobilization. Treat as life threatening as femoral artery winds around.
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Femoral stress fracture |
E: Overuse (10-25% all stress fractures), excessive downhill running/jumping. S&S: Persistent pain in thigh/groin, antalgic gait, may be positive trendelenburg sign. Xray. M: Vary on location. Lateral to femoral neck = complicated, others = better. |
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Osteitis Pubis |
E: Repetitive stress on pubic symphesis, distance, runners, football, wrestling S&S: Chronic pain and inflammation of groin, pint tenderness, pain w/ running, sit ups, squats. Acute case may be result of bike. M: Rest, NSAIDS, gradual return to activity, |
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Rehabilitation |
Good physical conditioning, CV fitness, edurance, strength. Flexibility Neuromuscular cotnrol/proprioception Joint mobilization Closed kinetic chain exercises. |