Hip Pointer
Brent S. E. Rich
BasicsDescription
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Iliac crest contusion
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Synonym(s): Bruised hip or contusion
Epidemiology
Most common in contact/collision sports such as football, wrestling, soccer, and lacrosse
Risk Factors
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Collision sports
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Inadequate iliac crest protection
DiagnosisHistory
Direct blow to the iliac crest
Physical Exam
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Signs and symptoms:
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Acute, severe pain at the site of contusion
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Athlete usually not able to continue activity
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Posture often flexed to side of injury
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Physical examination:
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Inspect for swelling, deformity, or ecchymosis.
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Tenderness to palpation over iliac crest
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Abdominal exam may reveal muscle spasm but should not be tender to palpation.
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Weakness and pain with active abdominal contraction, trunk rotation, side bending, and/or hip flexor contraction
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Diagnostic Tests & Interpretation
Imaging
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Plain anteroposterior (AP) pelvis radiographs to rule out fracture
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Oblique views may be helpful.
Differential Diagnosis
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Compression fracture to iliac crest
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Avulsion fracture of anterosuperior iliac spine
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Intra-abdominal injury
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Avulsion of internal/external oblique, latissimus dorsi, and/or paraspinals
P.309
Treatment-
Analgesia:
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Minimize bleeding and swelling with compression and ice.
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Narcotics may be appropriate for 1st 48–72 hr.
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NSAIDs are indicated at onset until resolution.
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Some clinicians prefer to give corticosteroid burst to decrease symptoms.
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Modalities per certified athletic trainer or physical therapist in acute phase
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Additional Treatment
Additional Therapies
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Crutches for partial or non–weight-bearing may be necessary for 1st few days of treatment.
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Some clinicians prefer to inject with local anesthetic and corticosteroid to decrease symptoms and speed recovery; increases risk of infection and bleeding
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Rehabilitation:
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Gentle abdominal and hip stretching when tolerated
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Gradual abdominal and hip strengthening
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Progressive functional activity
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Protection with padding on return to play
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Ongoing CareFollow-Up Recommendations
For evidence of intraabdominal trauma or displaced iliac crest fracture
Additional Reading
Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. 2001;29:521–533.
CodesICD9
924.01 Contusion of hip
Clinical Pearls
Return to play can take place when there is minimal to no tenderness at the contusion site, near-normal or normal abdominal and hip muscle strength, full range of motion to hip flexion, trunk rotation, and sidebending. Athlete then should be given adequate protection/padding.