What is a Hip pointer?

By James M. Paci, MD

A hip pointer is a contusion, or bruise, of the iliac crest, the bone along the brim of the pelvis, and its surrounding structures. Other effected structures may include the tensor fascia lata, the external oblique muscle and the greater trochanter of the femur.  In severe cases a hematoma, a collection of blood, may form and cause a palpable fluctuant mass beneath the skin. Hip pointers are usually the result of a direct blow to the pelvic brim, often in contact sports like football or ice hockey, or after a fall directly onto the hip. 

What are the symptoms of a hip pointer? 

A hip pointer is associated with pain over the iliac crest, bruising and hematoma may also occur, as may muscle spasm. In the case of a hematoma, a hip pointer may be associated with severe pain, as it dissects between the gluteus muscle and the iliac crest and can potentially press on the femoral or lateral femoral cutaneous nerves. 

How does one diagnose a hip pointer? 

While a hip pointer may be diagnosed clinically, in certain instances additional information may be garnered from imaging. Radiographs help to make sure that no fractures have occurred, while MRI and ultrasound may be used to determine the extent of the contusion and or hematoma present. X-rays are especially important in the adolescent patient who may have an avulsion fracture that mimics a hip pointer clinically.

What is the anatomy of the pelvic brim? 

The pelvic brim, or iliac crest, is the very superficial bony prominence felt beneath the skin on one’s side at the level of the belly button. It is a part of the pelvis girdle, and has attachments for many muscles, including the internal and external obliques, the tensor fascia lata, the gluteus medius, the latissimus dorsi, and the paraspinal muscles.

Hip pointer treatment 

The acute treatment of a hip pointer includes rest, ice and use of anti-inflammatory medications like ibuprofen or naproxen.

More Information: Read about sports injury treatment using the P.R.I.C.E. principle – Protection, Rest, Icing, Compression, Elevation.

Crutches may be needed for a couple of days after injury. It has been suggested to delay treatment, other than with ice, for 48 hours to allow all bleeding to stop prior to treating a deep contusion any further. An acute injection of corticosteroids (ie hydrocortisone) into the injured area may greatly reduce symptoms in the short term and speed up rehabilitation. There is however the risk of disordered muscle healing after corticosteroid injection, and as such decision to use this modality must be made on a case specific basis, with the athlete’s best interest in mind. Needle aspiration, or draining of, a painful hematoma may improve symptoms and decrease time to recovery. Physical therapy may be needed to regain motion and strength prior to return to play.

What is the prognosis of a hip pointer in an athlete? 

Return to play ranges based on the severity of injury, and treatment modalities used. With conservative treatment and physical therapy, on average one can expect full recovery within two to four weeks. An injured athlete may return to play once full range of motion and strength have returned.

What are the potential complications of a hip pointer? 

Potential complications include muscle fibrosis, delayed muscle soreness, and myositis ossificans (bone formation after hematoma within a muscle).

How can an athlete prevent a hip pointer? 

Proper fitting padding and protective equipment can help prevent injury occurrence or recurrence. 

References:

  • Anderson, K., S. M. Strickland, and R. Warren. “Hip and Groin Injuries in Athletes.” Am J Sports Med 29 4 (2001): 521-33. Print.
  • Arendt, Elizabeth A., American Orthopaedic Society for Sports Medicine., and American Academy of Orthopaedic Surgeons. Oku Orthopaedic Knowledge Update. Sports Medicine 3. 3rd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons, 2004. Print.
  • DeLee, Jesse, David Drez, and Mark D. Miller. Delee & Drez’s Orthopaedic Sports Medicine : Principles and Practice. 3rd ed. Philadelphia: Saunders/Elsevier, 2010. Print.

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