H IP AND T HIGH
Common Injuries

S TRAINS
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Quad, Hip Flexor, and groin strains commonly occur from explosive movement c/o “popping” or “pulling” feeling. Typically athlete can not continue activity.
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Strains that RTP too soon, or are left untreated with
RTP can result in avulsion fx

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Signs and Symptoms
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Pain, swelling, decreased ROM secondary to pain
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Treatment
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Rest, ice, ROM activities, electrical stimulation for tissue regeneration, Progressive Resistive Strength
Training

C ONTUSIONS
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Quadriceps Contusion -
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Results from a traumatic or repetitive impact to a relaxed quad muscle, compressing the muscle against the femur

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Quadriceps Contusion Cont’d
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Signs and Symptoms –
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Pain, temporary loss of function, capillary bleeding, swelling, pain to the touch
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Treatment –
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Immediately placed in flexion to stretch the muscle
(to prevent shortening), with ice pack to minimize swelling/bleeding and moderate pain. RICE and
NSAIDs prescribed as needed
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ROM (mild stretching), WBAT, and PRE within pain free ROM
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Heat, aggressive massage, and ultrasound are all contraindicated

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Hip Pointer –
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Occurs from a blow to an inadequately protected hip (iliac crest and abdominal musculature)
Considered one of the most debilitating and hard to manage injuries in contact sports.

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Hip pointer cont’d
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Signs and Symptoms –
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Immediate pain, spasms, temporary paralysis of muscles. As a result, Ath is unable to rotate trunk, or flex the thigh without pain.
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Treatment –
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RICE
Ice cup massage
Initially, steroid injection to manage pain, followed by oral NSAIDs
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Recovery 1 to 3 wks
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MOI is same as Iliac crest fx, Ath must be seen for Xray to RO

M YOSITIS O SSIFICANS
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Occurs from a severe blow or repeated blows to quadriceps muscle.
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Failure to control initial bleeding from quad contusion, or tx that it too aggressive can produce calcification in the muscle.
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Signs and Symptoms –
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Pain, weakness, soreness, swelling, decreased ROM
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Treatment –
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Sx excision 1 yr post injury.

F EMORAL F RACTURE
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Acute –
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Occurs in middle aged athletes, and elderly patients.
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Osteoporosis is a pre-disposing condition
High incident of Avascular Necrosis in adolescent patients due to skeletal immaturity and inadequate blood supply
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Fx w/o obvious deformity: c/o pain, no ROM, inability to WB. Ath is muscle-gaurding and resists any attempts to be moved.
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Hip is often EXTERNALLY rotated and slight adducted.
Shortening of the limb is sometimes evident.

F EMORAL F X
 http://www.youtube.com/watch?v=rO_nSjF_Jl0

F EM F X CONT ’ D

F EM FX CON ’ T
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Treatment –
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Immobilized and transported for immediate medical care. Physician will either do a close reduction, or open reduction, depending on placement of fracture and number of fracture sites.
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ORIF (open Reduction Internal Fixation) requires pins and rods
Following surgery, ath will be immobilized in hinge brace and will require PT.
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Rehabilitation typically takes 4 months

F EM FX CON ’ T
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Stress fracture
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Fairly uncommon, occurring most often in endurance athletes, and are more common in FEMALE athletes
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(MOI Overuse)
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Signs and symptoms –
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Pain in groin or anterior thigh, pain increasing during activity; pain may be referred to knee.
Positive Trendelenburg’s sign. Early x rays may not show fracture.
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Treatment –
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Complete rest with calcium and Vitamin D supplementation. Untreated stress fx can result in displaced femoral fx, then requiring sx

L EG L ENGTH DISCREPANCY
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Simply put: one leg is shorter than the other
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In non-active individuals, a
LLD of 1” will produce symptoms. In highly-active individuals, an LLD of 1/8” will produce symptoms.
3 types:
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True (Anatomical)
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Apparent
Functional

LLD C ONT ’ D
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True: Either Femur or Tibia is shorter when compared bilaterally. In some cases BOTH
Femur and Tibia are shorter.
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To Measure: Ath is supine, measurements taken from medial malleoli to ASIS
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Apparent: Not a true LLD. Bone length is the same when measured. Apparent shortening is caused by pelvic rotation. Can be fixed/treated.
Functional: Deformity in bone causes LLD, such as Genu Valgum/Genu Varum (bow-legged,
Pigeon-toed). Can not be fixed. Measurements taken from medial malleoli to umbilicus

Left: Genu Valgum (Knock-kneed)
Bottom: Genu Varum (bow-legged)

T ROCHANTERIC B URSITIS
Inflammation of the bursae caused by friction from the muscle or tendons surrounding the area.
Signs and Symptoms: c/o P in lateral hip which may radiate down to knee. TTP over greater trochanter. AT must r/o ITB tightness
Treatment: RICE, NSAIDS,
ROM, and PRE. Avoid running on inclined surfaces.
LLD and female athletes w/ increased Q-angle are more at risk

H IP D ISLOCATION
 https://www.youtube.com/watch?v=vXLLdU8-jO8
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MOI: Traumatic force along axis of femur when knee is flexed.
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Can displace anteriorly or posteriorly. Posterior dislocation are more common.
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Posterior dislocations cause femoral shaft to adduct and flex

H IP D ISLOC CONT ’ D
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Signs and Symptoms:
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Presents with a flexed, adducted, and internally rotated femur, extreme pain and no ROM available
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Treatment:
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Immediately reduce by medical professional.
Immobilize and rest for 2 weeks. Use of crutches for ambulation approx 4 weeks
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Complications:
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Serious tearing to capsular ligaments, fracture to femur (head or neck) Sciatic Nerve damage, later development of osteoarthritis, avascular necrosis of femoral head due to interrupted blood supply

H IP R EDUCTION
 http://www.youtube.com/watch?v=sGQZaqB48rw

H IP DISLOCATION O VERVIEW
 https://www.youtube.com/watch?v=mAL-Szu7qAc

H IP L ABRAL TEAR
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MOI:
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Commonly from overuse – running and cutting; can occur acutely from hip dislocation

H IP L ABRAL TEAR CONT ’ D
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Signs and Symptoms
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Most often asymptomatic. Occasionally: catching, locking, or clicking, pain in the hip or groin, and feeling stiff or having decreased ROM
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Treatment:
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Hips strengthening and proprioception, avoiding movements that cause pain, NSAIDs, injections of corticosteriod. If pain persists longer than 4 weeks, sx considered to removed or repair

L EGG -C ALVE -P ERTHES DISEASE
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Avascular necrosis of the femoral head
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Occurs in boys more than girls
Occurs in ages 4 to 10
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Etiology not always understood. Trauma only accounts for 25% on cases (femoral fx/hip dislocation)
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Signs and Symptoms:
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Pain in groin, abdomen or knees. Limping is common.
Evaluations will only show limited ROM and pain.
MRI/Xray needed

L EGG -C ALVE -P ERTHES DISEASE CONT ’ D
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Treatment:
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Complete bed rest. If treated in time, femoral head could re-vascularize and re-ossify
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Complications:
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Head of the femur will become ill-shaped and cause osteoarthritis in the future

S LIPPED C APITAL F EMORAL E PIPHYSIS
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MOI: idiopathic potentially related to a growth hormone
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Mostly seen in boys, ages 10-17
Tall and thin, or obese
Trauma only account for 25% of cases (femoral fx/hip dislocation)
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Signs and Symptoms:
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Similar to those of LCP
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Treatment:
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Minor slippage: rest and NWB may prevent further slippage
Major displacement: corrective surgery required

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S NAPPING H IP S YNDROME
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ITB moving over the greater trochanter of the femur
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Excessive repetitive movements found in athletes such as dancers, gymnasts, hurdlers, and sprinters – creates a muscle imbalance
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Signs and Symptoms:
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Pain, with a visible “clunk” while patient re-enacts motion
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Treatment:
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Decrease inflammation and pain with ice, NSAIDs, stretching and strengtheing

S NAPPING H IP S YNDROME
 https://www.youtube.com/watch?v=SUXOqfT2zC
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