Ebook Primary Care for Sports and Fitness: A Lifespan Approach (Part 2)

10 Conditions Involving the Hip, Pelvis, and Sacral and Lumbar Spines Tina L. Claiborne, PhD, ATC, and Brian J.Toy, PhD, ATC Anatomy of the Hip,Pelvis, and Sacral and Lumbar Spines Bones and Joints Motions Ligaments, Bursae, Nerves, and Intervertebral Disks Muscles and Tendons Examination of the Hip,Pelvis, and Sacral and Lumbar Spines History Physical Examination Musculoskeletal Imaging Conditions of the Hip,Pelvis, and Sacrum Contusion of the Iliac Crest (Hip Pointer) Iliotibial Band Friction Syndrome Snapping Hip Syndrome and Greater Trochanter Bursitis Adductor Strain (Groin Strain) Sacroiliac Joint Dysfunction Conditions of the Lumbar Spine General Low Back Pain Intervertebral Disk Herniation Spondylolysis and Spondylolisthesis Lifespan Considerations Hip Degeneration (Osteoarthritis) Avascular Necrosis Legg-Calvé-Perthes Disease Slipped Capital Epiphysis Apophyseal Avulsion Fractures Case Study 267 268 PART 2 Orthopedic Conditions hen combined with the thigh, knee, leg, and foot, the hip and pelvis com-plete the lower extremity. Along with the lumbar spine, these structures form the center of the body’s motion, transfer and dissipate external forces entering the body, and provide the body with its primary support for posture.They also coordinate and synchronize movement between the lower portion of the axial skeleton and the rest of the lower extremity. Consequently, injury to any of these structures may lead to debil-itating pain and dysfunction. Not only can this limit a person’s ability to participate in sports, it can also interfere with the completion of activities of daily living (ADLs) such as sitting, standing, walking, and climbing stairs. Anatomy of the Hip,Pelvis,and Sacral and Lumbar Spines The anatomy of these regions is extremely complex. Consequently, this review is lim-ited to those structures health care professionals need to know to evaluate traumatic and nontraumatic conditions that typically occur in patients seen in the primary care setting. Bones and Joints Bones in this region include the femur; pelvic, or innominates; and vertebrae. Joints include the hip, sacroiliac, intervertebral, and facet (Figs. 10.1 and 10.2). As discussed in Chapter 9, the femur, in addition to being the largest long bone in the body, is a major weight-bearing structure. Its proximal bony landmarks include the head, neck, and lesser and greater trochanters. The pelvis is composed of three separate bones: the ilium, ischium, and pubis.These bones fuse together shortly after birth in the acetabulum. It is the cup-shaped acetabulum that accepts the head of the femur to form the hip, or coxofemoral, joint. FIGURE 10.1 Bony anatomy of the proximal femur. From Levangie and Norkin: Joint Structure and Function: A Comprehensive Analysis, 4th ed. 2005. Philadelphia: F.A. Davis Company, Fig. 10-4, pg 358, with permission. CHAPTER 10 Conditions Involving the Hip, Pelvis, and Sacral and Lumbar Spines 269 Sacroiliac joint Posterior superior iliac spine Sacrum Iliac crest Ilium Iliac fossa Body of ilium Acetabulum Ischium Ischial tuberosity Symphysis pubis Posterior inferior iliac spine Anterior superior iliac spine Anterior inferior iliac spine Pubis FIGURE 10.2 Bony anatomy of the pelvis, sacrum, and sacroiliac joints. Adapted from McKinnis: Fundamentals of Musculoskeletal Imaging, 2nd ed. 2005. Philadelphia: F.A. Davis Company, Fig. 9-1, pg 292, with permission. Bony landmarks associated with the ilium, the largest of the three pelvic bones, include the iliac fossa and the iliac crest. This crest terminates anteriorly as the anterior superior iliac spine (ASIS) and posteriorly as the posterior superior iliac spine (PSIS). Just distal to these are the anterior inferior iliac spine (AIIS) and posterior inferior iliac spine (PIIS), respectively. Running medially from each acetabulum, the pubic bones join at the pubic symphysis. The ischium, which extends posteriorly from the pubis and acetabulum, maintains the large ischial tuberosity, also called the sit bone because it is the prominence on which we put pressure when we sit. The spinal column is composed of 33 vertebrae, which are arranged as follows: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccyx (Fig. 10.3). Each of these areas maintains its own natural curvature, adding to the overall health of the spine. The lumbar curve is concave, whereas the sacral is convex.The five lumbar vertebrae consist of the following bony landmarks: spinous process, lamina, transverse processes, pedicle, body, and superior and inferior articular processes (Fig. 10.4). These vertebrae, as all others above this level, serve to protect the spinal cord as it runs in the vertebral, or spinal, canal, a channel formed by the vertebral foramen of each vertebra. Because the spinal cord typically ends at the level of L1/L2, the foram-ina of the lower lumbar vertebrae house the cauda equina (Fig. 10.5), a bundle of nerves that arise from the terminal end of the spinal cord.Articulations in this region include the intervertebral joints (IVJs) and the facet joints (FJs) (Fig. 10.3).The IVJs are formed between the bodies of the vertebrae, and the FJs are formed as the artic-ulation between the inferior articular process of the superior vertebrae articulates with the superior articular process of the inferior vertebrae.The FJs also help form 270 PART 2 Orthopedic Conditions Cervical vertebrae Thoracic vertebrae Lumbar vertebrae Sacrum Coccyx 1 2 3 4 5 6 1 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 Intervertebral disks and joints Intervertebral foramen Facet joints Articular surface for ilium FIGURE 10.3 The vertebral column, intervertebral disks, intervertebral foramen, and facet joints. The figure also shows where the ilium articulates with the sacrum to form the sacroiliac joint. ASIS = anterior superior iliac spine. Adapted from Scanlon: Essentials of Anatomy and Physiology, 5th ed. 2007. Philadelphia: F.A. Davis Company, Fig. 6-10A, pg 120, with permission. a separate intervertebral foramen (Fig. 10.3), which, as expanded on later in this chapter, allows for the passage of individual nerve roots exiting the spinal cord. The region between the superior and inferior facets of a vertebra is termed the pars interarticularis, a common area of injury. Unlike those in the lumbar region, the vertebrae that compose the sacrum and coccyx are fused.Though this makes these structures fairly immobile, the sacrum does articulate with the fifth lumbar vertebrae to form an IVJ and FJs. The sacrum also articulates with the posterior aspect of each ilium to form the sacroiliac joints (SIJs) (Fig. 10.2).These joints serve as the union between the axial skeleton and the lower extremity. CHAPTER 10 Conditions Involving the Hip, Pelvis, and Sacral and Lumbar Spines 271 FIGURE 10.4 Portions of a typical lumbar vertebra. Adapted from McKinnis: Fundamentals of Musculoskeletal Imaging, 2nd ed. 2005. Philadelphia: F.A. Davis Company, Fig. 8-3, pg 251, with permission. Pedicle Transverse process Spinous process Body Spinal canal (vertebral foramen) Superior Lamin articular process Spinal cord C1 C2 C3 C4 C5 C6 C7 C8 T1 T2 T3 T4 T5 T6 T7 T8 T9 Cervical plexus Brachial plexus T10 T11 T12 L1 L2 Cauda equina L3 L4 L5 S1 S3S2 S5 CO1 Lumbar plexus Sacral plexus Sciatic nerve FIGURE 10.5 The spinal nerves, plexuses, and sciatic nerve. Adapted from Scanlon: Essentials of Anatomy and Physiology, 5th ed. 2007. Philadelphia: F.A. Davis Company, Fig. 8-4, pg 173, with permission. ... - tailieumienphi.vn