Introduction
Background
A hip pointer is a contusion to the iliac crest, the surrounding soft tissue structures, or the greater trochanter of the femur. Typically, the injury is caused by a direct blow or fall. Hip pointer injuries occur most commonly in contact sports (eg, football, hockey), but they can also occur in noncontact sports (eg, volleyball) as a result of a fall onto the hip or side. Pain and tenderness in this region can limit an athlete's participation in sports.
Frequency
United States
No specific statistics for frequency of hip pointer injuries are available; however, hip injuries generally comprise 5-9% of high school athletic injuries.
Functional Anatomy
The anterior iliac crest region of the hip and the greater trochanter of the femur have a minimal amount of overlying fatty tissue or muscle and are more susceptible to contusion and injury than more protected regions of the body.
The iliac crest has multiple muscle origins and insertions, including the sartorius, the tensor fascia lata, the internal and external obliques, and a portion of the rectus femoris muscle.
Clinical
History
Obtain a detailed history, including the mechanism of injury and the patient's description of his or her symptoms. A hip pointer is usually an acute injury, and the patient can typically recall a precipitating event, though some may present 24-48 hours after the initial injury.
- Hip pointer injuries are usually caused by a direct blow to the iliac crest or greater trochanter in contact sports such as football or hockey.
- A hip pointer may also be caused by a fall onto the hip in sports such as soccer or skiing.
- Typically, the patient presents with the sudden onset of hip pain in the iliac crest or greater trochanteric region after sustaining trauma.
- The pain is localized and may be exacerbated with activities such as running, jumping, twisting, or bending.
- The pain can limit range of motion (ROM) at the hip joint and/or rotation of the trunk if the abdominal musculature is involved.
Physical
Physical examination should include abdominal examination to exclude trauma to intra-abdominal organs. Examination should consist of visual inspection, palpation, passive and active ROM assessment, sensory testing, and gait analysis.
- Contusion or swelling may be evident upon visual inspection. The athlete usually reports increased pain with palpation of the affected iliac crest or greater trochanter. Limited ROM of the hip secondary to pain may also occur.
- Motor strength of the hip flexor and extensors should be intact. Strength of the hip abductors and external rotators may be limited by pain if the contusion includes the sartorius muscle and/or the iliotibial tract.
- Sensation should be intact to light touch, although this portion of the examination may be limited if the patient has severe pain.
- Initial gait analysis may also be limited secondary to pain, but it provides a baseline from which to evaluate recovery.
Causes
- The primary cause of hip pointers is a direct blow or fall onto the iliac crest or greater trochanter.
- Risk factors include participation in contact sports and wearing limited or no padding or protective equipment in the region.
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References
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Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury?. J Athl Train. 9 2004;39(3):278-279. [Medline]. [Full Text].
Meyers WC, Ricciardi R, Busconi BD, et al. Groin pain in athletes. In: Ardent EA, ed. Orthopadics Knowledge Update: Sports Medicine 2. Rosemont, Ill: American Academy of Orthopedic Surgeons; 1999:281-289.
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Winfield C. Common hip injuries. In: Sallis RE, Massimino, eds. ACSM's Essentials of Sports Medicine. St. Louis, Mo: Mosby; 1991:440-441.
Further Reading
Keywords
iliac crest contusion, hip bruise, hip trauma, hip injury, hip pain, groin injury, contact sports, football, hockey, soccer, skiing, volleyball, high school athletic injuries, anterior iliac crest region, greater trochanteric region, femur, sartorius, tensor fascia lata, obliques, rectus femoris muscle, range of motion, ROM, ROM exercises
