Updated: 6/3/2017

Iliac Crest Contusion (Hip Pointer)

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https://upload.orthobullets.com/topic/3090/images/hip[1]_moved.jpg
Introduction
  • Mechanism direct trauma or crushing
    • common in contact sports 
  • 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? Tested Concept

QID: 249
FIGURES:
1

Hip flexor strain

3%

(97/3019)

2

Hip pointer

92%

(2772/3019)

3

Apophysitis

3%

(98/3019)

4

Piriformis syndrome

0%

(8/3019)

5

Trochanteric bursitis

1%

(35/3019)

L 1 C

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