Pelvis sport injuries

Question 1

What is this ?

Answer 1

Anterior spine iliac spine avulsion

• young athletes
• throught the physis
• mechanism
  
  • indirect trauma
  • sudden and forceful contractionof sartorius and TFL
  • occurs during hip extension

Question 2

What muscles originate from the anterior superior iliac spine?

Answer 2

• Sartorius
  
  • insertion: superior medial surface of tibial shaft nr tibial tuberosity- joins gracilis and smeitendinosis at pes anserius
  • action: flexes and laterally rotates hip, flexes knee
  • Innervation: Femoral n L2/3/4
• Tensor Fasica Lata
  
  • insertion: iliotibial band
  • action: helps stabilise and steady hip/knee joints by putting tension on the iliotibial abnd of fascia
  • inneravation:super glutean n L4,5,S1

Question 3

What is the tx of Anterior spine iliac spine avulsion?

Answer 3

Non operative

• Rest, Protected weight bearing with crutches, early rom with stretching = most cases

Operative

• ORIF of avulsion fx
  
  • if displacment >3cm
  • painful non unions

Question 4

What is this?

Answer 4

• Anterior inferior spine iliac spine avulsion
• an apophyseal injury seen in adolscents
• M>F
• occurs often in sports involving kicking
• occurs due to eccentric contracture of the rectus femoris as hip extends and knee is flexed
  *

Question 5

Describe the anatomy of rectus femoris?

Answer 5

• Origin
  
  • Straight head from Ant inferior iliac spine
  • Reflected head from groove above actebulum
• insertion: base of patella to form the more central portion of the quadriceps femoris tendon
• action: extends the knee
• Inervation; muscular branch of femoral n L2-4
• arterial supply: lateral circumflex A

Question 6

What is the tx of Anterior inferior spine iliac spine avulsion

Answer 6

Non operative

• Bed rest, ice activity modification
  
  • most cases
  • hip flexed for 2 weeks
    
    • position lessn stretch of affected muscle and apophysis
    • guarded weight bearing 4 weeks

Question 7

What is osteitis pubis?

Answer 7

• Inflammation of the pubic symphysis caused by repetitive trauma ( adduction/abduction)
• common soccer,hockey, football/running
• vague ill defined symptoms
• localsied tenderness over pubic symphysis
• xray- bony erosions, and often diastatis of symphysis, degenerative change within joint
• TX
  
  • nsaids, rest , activity modification
  • may take several months to resolve

Question 8

What is meralgia paresthetica?

Answer 8

• Compressive neuropathy of lateral femoral cutaneous nerve
  
  • exacerbated by tight belts
  • prolonged hip flexion
  • non op tx, nsaids

Question 9

What is obturator nerve entrapement?

Answer 9

• Compressive neuropathy of obturator n in ptw with well developed hip adductors
  
  • skaters
  • -> chronic medial thigh pain
• TX
  
  • non op

Question 10

What ilioinguinal nerve entrapment?

Answer 10

• Compression neuropathy caused by hypertrophy abdominal muscels
• pain worsened by hyperextension of hip

Tx

• majority non op
• op in refractory cases

Question 11

What is piriformis syndrome?

Answer 11

• A condition characterised by sciatic symptoms leg pain due to extrapelvic scaitic nerve compression at the hip
  
  • sometimes called= deep gluteal syndrome
  • ocurs
    
    • anterior to piriformis
    • posterior to obturatir internus/gemelli complex
    • at level of ischial tuberosity
• anatomy anomalies may contribute to compression
  
  • bipartite pirifromis
  • variations in path of sciatic n
  • tumours
  • aneursym of gluteal artery
• Pain down back of leg
• FAIR test = flexion, adduction, internal rotation= symtpoms

Question 12

What is the tx of piriformis syndrome?

Answer 12

Non operative

• rest, nsaids,muscle relaxants, physio, steriod injection
  
  • furst line of tx
  • focus on stretching piriformia muscle, short external rotatios
  • corticosteriod injections directed nr piriformis muscle

Operative

• piriformis release and external siatic neurolysis
• in refractory cases