MSK: THE HIP POINTER

WHAT IS A HIP POINTER? A term used to describe an Iliac crest contusion

Image from : http://kingbrand.com/Hip_Pointer_Injury.php

ETIOLOGY: Trauma - fall/ blow
DDx: #NOF (Imaging), Thigh or gluteal compartment syndrome (compartment pressure management if suspected)
MANAGEMENT:
Immediate  :
         Rule out intra-abdominal injuries (Refer to general surgeon if present)
         Rule out fractures (Imaging or Refer to orthopedic surgeon if suspected ),
         Analgesic medication (Paracetamol, paracetamol + opioid.Local anaesthetic injection might also help, Pain out of proportion to clinical findings- CT might be necessary)
PRICE: Prevention of further injury, Rest, Ice, Compression, (E=Elevation of PRICE might not be applicable here)
Anti inflammatory Medication (Ibuprofen/ Ketoprofen/ Naproxen. No evidence for corticosteroid injection, tho it might be given if trochanteric bursitis develops)
Crutches - if antalgic gait
Exercises
1. As the pain starts decreasing, ROM exercises can start. Resistance exercises can be given.
2. Prevention of falls - balance training
3. Sport specific training

Padding - of athlete who returns to sport (half inch thick pad)

COMPLICATIONS
1. Watch out for hematoma
    Symptom- Increasing pain  
    Sign- decreased sensation of overlying skin.
    Aspiration might be necessary
2. Watch out for myositis ossificans (Plain Xray, Alk Phos serielly)
3. If pain persists more than 2 weeks, refer to ortho  (Bone scan may be necessary) 
4. Trochanteric bursitis / Chronic bursitis

PROGNOSIS  Usually good. Can return to work when the swelling and pain allow. Usually around 2-3 weeks or less.

References

J Athl Train. 2004 Jul-Sep; 39(3): 278–279Does Cryotherapy Improve Outcomes With Soft Tissue Injury?  Hubbardand Denegar

Hip Pain in Athletes . ADKINS. FIGLER, Am Fam Physician. 2000 Apr 1;61(7):2109-2118

http://www.aafp.org/afp/2014/0101/p27.html