What is Hip Pointer Injuries?
A hip pointer is a type of bruise occurring at the top crest of the hip bone or the large bump on the top side of the thigh bone, usually following a direct hit or impact. This injury needs to be managed by a variety of healthcare professionals, including athletic trainers, clinical providers, primary care doctors, and sports medicine specialists. Most of these injuries get better with common, non-surgical treatments.
What Causes Hip Pointer Injuries?
The front part of the iliac crest (the top ridge of the hip bone) and the greater trochanter (a bony bump on the thigh bone) usually have very little fatty tissue covering them. For this reason, they are more vulnerable to injuries from direct hits.
The main cause of these injuries is a direct hit to the iliac crest or greater trochanter, often during contact sports like American football and hockey. In American football, injuries can happen because of tackles and accidental collisions that happen often during games. The same can be said for rugby. In ice hockey, hip pointers, or painful bruising of the hip bone, can happen when a player is pushed into the boards or makes contact with another player or their gear. Other non-contact sports and scenarios involving trauma, such as falls or car accidents, can also lead to bruises on the iliac crest. In these cases, the injury often happens because of a direct fall or a traumatic hit.
Risk Factors and Frequency for Hip Pointer Injuries
Sports injuries are less likely to affect the hip and pelvis compared to the knee or ankle. Only around 5 to 10% of total sports injuries occur in the hip area. Among these, hip pointers represent an even smaller fraction. A look at injuries reported by the National Football League from 1997 to 2006 shows an occurrence rate of just 0.3%. On average, these injuries resulted in players missing about 5.6 days of training.
Signs and Symptoms of Hip Pointer Injuries
When evaluating a patient with a potential hip pointer injury, it’s important to understand their current symptoms and how the injury occurred. A hip pointer is often the result of a hard hit or fall that impacts the hip or thigh. More specifically, the damage usually involves the iliac crest (the top part of the hip bone) or the greater trochanter (the bump below the hip).
Common signs of a hip pointer include:
- Various degrees of bruising or skin discoloration in the impacted area
- Pain and tenderness on the hip bone or around the injured area
- Difficulty moving the hip due to pain
- Weakened ability to move the leg away from the body, while the ability to move the leg forward and backward should remain normal
- Possible weakness in rotating the hip outward due to discomfort
Testing for Hip Pointer Injuries
If there’s a suspicion that you might have a bone injury or a condition known as myositis ossificans, your doctor will likely order X-rays. This is particularly important for high school and college athletes, as certain bones in the hip and pelvis can continue to develop and fuse into your twenties. Young and adolescent athletes may need to be checked for unique hip and pelvic injuries where a piece of bone is torn away by a muscle or tendon’s forceful contraction. These could include:
- Iliac crest avulsion injuries, which occur when the abdominal muscles pull away part of the hip bone.
- ASIS avulsion injuries caused by a tear in the muscle that helps flex your hip (sartorius) or the muscle that helps you move your thigh upward and inward (tensor fascia lata).
- AIIS avulsion injuries caused by a tear in the muscle that flexes your hip (rectus femoris).
- Ischial tuberosity avulsion injuries, which result from a tear in the hamstring muscles.
In cases of an isolated hip pointer, a type of bruise to the hip bone, the X-rays typically don’t show any abnormal results. However, if your pain persists or seems worse than what your doctor would expect from the physical examination, a CT scan may be necessary. If your initial symptoms don’t seem to improve, a bone scan might be needed to rule out stress fractures. An MRI could show a large collection of blood outside of the blood vessels (hematoma) if you have a hip pointer, but it wouldn’t reveal any further major findings.
It’s important to note that hip pointer needs to be distinguished from several other conditions causing hip and pelvic discomfort, such as chronic exertional compartment syndrome, femoral neck fracture, avascular necrosis, hip fracture or dislocation, tendonitis, iliotibial band syndrome, osteitis pubis, sacroiliac joint injury, snapping hip syndrome, and slipped capital femoral epiphysis.
Treatment Options for Hip Pointer Injuries
When you injure your hip, a condition commonly known as a “hip pointer”, the first steps in treatment usually include applying ice to the area, taking pain medication designed to reduce inflammation, using something to compress the area, getting plenty of rest, and staying off the affected leg as much as you can, based on how much pain you’re experiencing.
As your pain reduces, you should start doing exercises that improve your motion range and build strength against resistance. Sometimes, a collection of blood, known as a hematoma, can form at the injury site. Draining this can offer some relief from pain and may even prevent a condition known as “myositis ossificans”, where bone begins to form within the muscles or other soft tissues.
A local anesthetic, think of it as a numbing medicine, like lidocaine or bupivacaine, can be applied to provide short-term relief from pain. This is generally safe, although there isn’t significant scientific data that supports this. The use of corticosteroids, another type of medication, doesn’t have a lot of research backing it up either, but it’s generally accepted in the sports medicine field.
If a condition known as “compartment syndrome” is suspected, then the pressure within your muscles will need to be measured. Compartment syndrome is a painful condition that happens when pressure within your muscles build up to dangerous levels, which can reduce crucial blood flow. This usually requires consultation with an orthopedic surgeon, or a doctor who specializes in sports medicine.
It’s also advised to consult an orthopedic surgeon if a piece of bone has been torn away by a muscle, tendon or ligament (a condition known as an “avulsion fracture”), or if you’re still in pain two weeks after your injury.
In many cases, you will be prescribed physical therapy as part of your recovery process. Physical therapy is a type of treatment that utilizes exercises and other techniques to help patients recover from injuries and gain back their strength and mobility.
What else can Hip Pointer Injuries be?
When it comes to diagnosing a hip pointer or an iliac crest contusion, there are several conditions that may exhibit similar symptoms. Here are some of them:
- Chronic exertional compartment syndrome
- Femoral neck fracture or hip fracture
- Avascular necrosis, also known as osteonecrosis
- Hip dislocation or partial dislocation (subluxation)
- Hip tendonitis
- Iliotibial band syndrome
- Inflammation of the pubic symphysis or osteitis pubis
- Sacroiliac joint injury
- Snapping hip syndrome
- Slipped capital femoral epiphysis (SCFE), commonly seen in adolescent patients
By considering these potential conditions, physicians can more accurately diagnose a hip pointer or an iliac crest contusion.
What to expect with Hip Pointer Injuries
Most people are usually able to get back to their usual activities within a span of two to three weeks.
Possible Complications When Diagnosed with Hip Pointer Injuries
Chronic pain and dysfunction, inability to return to athletic performance levels achieved before, and a diagnosis that was missed, which can lead to continuous pain and disability are some of the common issues you might face.
- Chronic pain or dysfunction
- Inability to regain previous athletic performance
- Missed diagnosis resulting in constant pain and disability
Preventing Hip Pointer Injuries
If the patient suffers from other health conditions such as diabetes, inherited bone disorders, or if they are taking blood-thinning medications, it’s important they fully understand their situation. They should either avoid certain activities (like sports) or be extra careful with their movements. This is to prevent any additional health complications or injuries.
