Updated: 6/1/2021

Iliac Crest Contusion (Hip Pointer)

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  • Summary
    • An illiac crest contusion (hip pointer) is a traumatic hematoma overlying the iliac wing that occurs due to direct trauma or crushing injury, most commonly during contact sports.
    • Diagnosis is made clinically with tenderness over the iliac crest with extensive contusion and hematoma near iliac crest.
    • Treatment is nonoperative with NSAIDs, rest and stretching.
  • Etiology
    • Pathoanatomy
      • hematoma occurs into area surrounding iliac wing
        • and can cause bleeding into hip abductor muscles
      • rule out avulsion of the iliac apophysis
        • in adolescent patients
  • Anatomy
    • Iliac crest is origin of several muscles any of which can be involved
      • sartorius
      • tensor fascia lata
      • gluteus medius
      • abdominal muscles
        • transverse or oblique muscles
  • Presentation
    • Symptoms
      • pain near iliac crest
    • Physical exam
      • contusion and hematoma near iliac crest
      • affected hip weakness
      • decreased range of motion
  • Imaging
    • Radiographs
      • usually unremarkable
    • MRI
      • usually unremarkable
      • can show large hematoma
  • Treatment
    • Nonoperative
      • rest, NSAIDS, steroid injections, and therapy
        • indications
          • main line of treatment
        • technique
          • medications
            • NSAIDs and muscle relaxants may be beneficial
          • therapy
            • focused on stretching the muscles about the iliac crest
            • place affected leg on maximum stretch
          • steroid injections
            • corticosteroid injection directed near iliac crest
          • return to play
            • additional padding during return to play

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Questions (1)

(OBQ06.238) A professional hockey player is checked into the boards and develops a painful hip. He is point tender over the iliac crest. A clinical photo is shown in Figure A. What is the most likely diagnosis?

QID: 249
FIGURES:
1

Hip flexor strain

3%

(103/3274)

2

Hip pointer

91%

(2993/3274)

3

Apophysitis

4%

(117/3274)

4

Piriformis syndrome

0%

(13/3274)

5

Trochanteric bursitis

1%

(38/3274)

L 1 C

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