Dr. Martin's notes

Wednesday March 15, 2017

Hip and thigh injuries

Hip and Thigh injuries

The most frequent location for bursitis is over the outside of the hip. This is called greater trochanteric bursitis. This condition is commonly seen in athletes who do not sufficiently stretch and warm up this area. Tenderness over the outside of the hip, one of the symptoms of bursitis, can frequently be made worse by walking, running, or twisting the hip in certain directions. The initial treatment for bursitis is limiting activity, followed by stretching exercises and ice massage. Nonsteroidal anti-inflammatory medicines are also quite helpful.

A hip fracture refers to a break of the top part of the femur where it connects to the pelvis. Hip fractures are classified into many types. The most common are femoral neck fractures, intertrochanteric fractures and subtrochanteric fractures.
Most hip fractures are diagnosed by a history of a fall or an accident followed by severe hip pain. The leg may appear abnormally rotated, and any attempt to move the hip will result in a significant increase in pain. X-rays are used to confirm the diagnosis.

Quadriceps and Hip Flexor Strains
Strains of the quadriceps and hip flexors are common in sports requiring jumping, kicking, or repetitive sprinting. Most quadriceps strains involve the rectus femoris. Hip flexor strains may involve the rectus femoris and/or iliopsoas muscle. Initial treatment includes icing, compression with an elastic wrap, and anti-inflammatory medications. As with all medications, a physician should be consulted. Rehabilitation should be progressive and sport-specific.

Hamstring Strains
The hamstrings are actually composed of three separate muscles: the biceps femoris, semitendinosus, and semimembranosus. These muscles originate at the ischial tuberosity of the pelvis and attach behind the knee. These muscles span two joints and are prone to strain during athletic activities. Any of the three hamstring muscles may be injured, but the long head of the biceps femoris is most frequently affected. A hamstring strain is commonly called a "pulled hamstring." A hamstring strain can range from microtears in a small area of muscle to a complete tear in the muscle or the tendons that attach the muscle to bone. Sudden, explosive starts and stops and chronic overuse of the hamstring muscle-tendon unit are the most common causes of pulled hamstrings. More severe hamstring pulls often result from sprinting or making a quick start or stop when the leg is extended.

Nonsurgical treatment consists of a combination of RICE (rest, ice, compression, and elevation), medication, and physical therapy. Depending on the severity of the hamstring injury, the athlete's physician may prescribe crutches to keep weight off the injured leg for up to three weeks. Massage from a trained therapist can help relax and tone the hamstring muscles after an injury. The athlete should begin a rehabilitation program as soon as possible after a hamstring strain.

Adductor (Groin) Strains
Adductor strains are common in sports requiring sudden, sideways changes in direction, such as skating, soccer, track and field, and tennis. Adductor strains are difficult to treat, and the risk of reinjury is high. As with hamstring strains, the athlete should be carefully monitored during rehabilitation. Treatment involves rest, ice, and anti-inflammatory medications, followed by adductor stretching and strengthening exercises.

IIiotibial Band Syndrome
The iliotibial band is a thick band of fibrous tissue that runs down the outside of the leg. It begins at the hip and extends to the outer side of the tibia just below the knee joint. Irritation usually occurs over the outside of the knee joint, at the lateral epicondyle end of the femur. Between these structures is a bursa that should facilitate a smooth, gliding motion. However, when inflamed, the iliotibial band does not glide easily, and pain associated with movement of the knee joint is the result. Usually the pain worsens with continued movement and resolves with rest.

People who suddenly increase their level of activity, such as runners who add mileage, often develop iliotibial band syndrome. Others who are prone to iliotibial band syndrome are individuals with mechanical problems: people who overpronate, have leg length discrepancies, or are bow-legged. Treatment of iliotibial band syndrome begins with analysis of the athlete's gait and training program, to rule out mechanical problems or training errors that may predispose the athlete to this condition. The athlete will need to reduce activity level until symptoms subside.

Quadriceps Contusions
Quadriceps contusions are common in football, rugby, soccer, and basketball, usually caused by a direct blow to the thigh from a helmet or knee. The severity of the contusion is usually graded by the range of motion in the hip at the time of evaluation. Treatment consists of immediate compression, ice (applied during the first 24 to 48 hours) and crutches to assist with weight bearing. Massage is contraindicated and may in fact cause further damage (bleeding and increased pain), Complete recovery can be expected, but recovery time may range from two days to six months.

Myositis Ossificans
Myositis ossificans is a very painful condition m which an ossifying mass (calcium deposits) form within the muscle. In many cases, myositis ossificans is the result of recurrent trauma to a quadricep muscle that was not properly protected after an initial injury. A history of injury should always be investigated to rule out other causes.The definitive diagnosis of this condition is made by x-ray, but usually not until at least four weeks after the injury.

In the early stages, treatment consists of heat, limitation of joint motion, and rehabilitative exercises within the limits of pain. Passive stretching and vigorous exercise during the first six months after injury are discouraged. The calcium mass usually is reabsorbed by the body, however, reabsorption may take three to six months. Surgical excision may be necessary if pain and limited motion persist beyond one year.

Iliac Crest Contusions
The iliac crest contusion, or "hip pointer," is a very painful injury caused by a direct blow to the hip. Hip pointers are common in football players who wear improperly fitting hip pads. Extreme tenderness, swelling, and ecchymosis over the iliac crest are classic signs and symptoms of a hip pointer. Treatment involves application of ice and compression.

Overuse Injuries
Overuse injuries are common in athletes who have focused their efforts on one sport. These injuries are caused by the cumulative effect of very low levels of stress-such as that caused by the repetitive action of running. Chronic muscle strains, stress fractures, tendonitis (overuse/overload fatigue within the tendon), snapping hip (iliopsoas tendon snapping over the head of the femur), and bursitis (inflammation and thickening of the bursal wall) are examples of overuse injuries. An athlete with an overuse injury should rest from the sport, that aggravated the injury and use cross-training techniques.

The injured athlete may complain of chronic, ill-defined pain over the groin and thigh, and initially be diagnosed with a muscle strain. If there is no history of acute injury, though, a stress fracture should be considered. If the symptoms do not resolve with rest and rehabilitative exercise, the athlete should be examined by a sports medicine specialist. Diagnosis is performed by using x-rays and/or bone scans. Treatment of stress fractures consists of rest and nonweight-bearing endurance exercises, such as running in water or swimming.