Hip Pointer/Contusion
Overview:
- contusion along upper or lower margin of iliac crest where abdominal and lower extremity musculature attach (4)
Pathogenesis:
- contusion to ASIS with swelling, inflammation, and possible hematoma or tearing of muscle-tendon attachments to iliac crest (1)
Causes/Risk Factors:
- direct blow from a collision or hard surface (1)
- contact sports, sports involving high-velocity objects, sports with high-risk of falls, not wearing protective padding (1)
Clinical Presentation:
- usually seen in young male athletes who participate in contact sports i.e. football, rugby
- s/s include:
- point tenderness, abrasion, contusion, hematoma, guarded/painful movements, antalgic gait
Contraindications/Precautions:
- visible deformity of iliac crest or crepitus may suggest a fracture and would need referral to physician
- limit activity and risk of trauma to hip if avulsion or fracture is present for approximately 6 weeks or cleared by physician
- consider damage to surrounding bone and soft tissue structures if weight bearing is not tolerated
- should rule out:
- muscle strain - iliotibial band syndrome
- pelvic/hip fracture - snapping hip syndrome
- femoral neck fracture - compartment syndrome
- osteitis pubis - sacroiliac joint injury
- epiphyseal separation/avulsion - hip tendonitis/bursitis
Differntial Diagnosis:
- plain radiographs to rule out pelvic fracture, femur fracture, or epiphyseal separation
- CT scan to rule out internal injury if condition persists
- can also use palpation, AROM, PROM, and special tests for the hip as differential diagnostic tools
Outcome Measures:
- gait assessment - posture assessment
- manual muscle testing - isokinetic testing
- goniometry - flexibility testing
- functional testing - patient satisfaction surveys
Clinical Bottom Line:
- treat with possible referral if an underlying fracture is suspected
- focus treatment on management of pain and edema in acute phase
- regaining lost mobility and strength deficits should be addressed as tolerated
References:
See "Hip Pointer" section of References page