eMedicine Specialties > Sports Medicine > Hip

Hip Pointer: Differential Diagnoses & Workup

Author: John M Martinez, MD, Medical Director, Primary Care Sports Medicine, Coastal Sports and Wellness Medical Center
Coauthor(s): Kenneth Honsik, MD, Consulting Staff, Department of Primary Care Sports Medicine, Kaiser Permanente
Contributor Information and Disclosures

Updated: Mar 6, 2009

Differential Diagnoses

Compartment Syndromes
Hip Tendonitis and Bursitis
Contusions
Iliotibial Band Syndrome
Femoral Head Avascular Necrosis
Osteitis Pubis
Femoral Neck Fracture
Sacroiliac Joint Injury
Femoral Neck Stress Fracture
Slipped Capital Femoral Epiphysis
Hip Dislocation
Snapping Hip Syndrome
Hip Fracture

Other Problems to Be Considered

Avulsion fracture of the iliac apophysis
Bursitis of the greater trochanter
Iliotibial band syndrome
Intra-abdominal injuries
Muscle strain injury (eg, external oblique tear, sports hernia)
Osteoid sarcoma
Periostitis/myositis ossificans
Pelvic or stress fracture
Soft-tissue tumors

In children, also consider slipped capital femoral epiphysis (if groin pain exceeds hip pain), avascular necrosis of the hip, Legg-Calve-Perthes disease, and transient synovitis.

Workup

Laboratory Studies

  • Typically, laboratory studies are not useful in the diagnosis of hip pointers.

Imaging Studies

  • Plain radiographs: Order radiographs if fracture or myositis ossificans is considered possible.
  • Computed tomography (CT) scans: Consider obtaining CT scans if the patient has continued pain or if his or her pain exceeds that expected from examination findings. CT scans can help clinicians to diagnose deep hematoma or internal injuries (eg, spleen).
  • Bone scans: Order a bone scan to exclude a stress response or fracture if initial radiographic findings are normal and the symptoms do not resolve or improve.

Procedures

  • If a significant hematoma is present, then aspiration can provide some pain relief and help prevent development of myositis ossificans or pressure and compression of local nerves (eg, lateral femoral cutaneous nerve).
  • Injection of a local anesthetic (eg, lidocaine) may provide short-term pain relief from a hip pointer.
  • Compartment pressures can be measured if a thigh or gluteal compartment syndrome is considered possible.

More on Hip Pointer

Overview: Hip Pointer
Differential Diagnoses & Workup: Hip Pointer
Treatment & Medication: Hip Pointer
Follow-up: Hip Pointer
References
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References

  1. Winfield C. Common hip injuries. In: Sallis RE, Massimino, eds. ACSM's Essentials of Sports Medicine. St. Louis, Mo: Mosby; 1991:440-1.

  2. Ruane JJ, Rossi TA. When groin pain is more than "just a strain": navigating a broad differential. Phys Sportsmed. 1998;26(4):78-103. [Full Text].

  3. Meyers WC, Ricciardi R, Busconi BD, et al. Groin pain in athletes. In: Ardent EA, ed. Orthopaedics Knowledge Update: Sports Medicine 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1999:281-9.

  4. Borowski LA, Yard EE, Fields SK, Comstock RD. The epidemiology of US high school basketball injuries, 2005-2007. Am J Sports Med. Dec 2008;36(12):2328-35. [Medline].

  5. Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury?. J Athl Train. Sep 2004;39(3):278-9. [Medline]. [Full Text].

  6. Adkins SB 3rd, Figler RA. Hip pain in athletes. Am Fam Physician. Apr 1 2000;61(7):2109-18. [Medline]. [Full Text].

  7. Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. Jul-Aug 2001;29(4):521-33. [Medline].

  8. DeLee JC, Farney WC. Incidence of injury in Texas high school football. Am J Sports Med. Sep-Oct 1992;20(5):575-80. [Medline].

  9. Feeley BT, Powell JW, Muller MS, et al. Hip injuries and labral tears in the National Football League. Am J Sports Med. Nov 2008;36(11):2187-95. [Medline].

  10. Gomez E, DeLee JC, Farney WC. Incidence of injury in Texas girls' high school basketball. Am J Sports Med. Sep-Oct 1996;24(5):684-7. [Medline].

  11. Schmitt KU, Nusser M, Boesiger P. [Hip injuries in professional and amateur soccer goalkeepers] [German]. Sportverletz Sportschaden. Sep 2008;22(3):159-63. [Medline].

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Further Reading

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Keywords

hip pointer, hip pain, hip injury, hip bruise, hip trauma, iliac crest contusion, groin injury, contact sports, football, hockey, soccer, skiing, volleyball, high school athletic injuries, anterior iliac crest region, greater trochanteric region, femur, sartorius, tensor fascia lata, obliques, rectus femoris muscle, range of motion, ROM, ROM exercises

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Contributor Information and Disclosures

Author

John M Martinez, MD, Medical Director, Primary Care Sports Medicine, Coastal Sports and Wellness Medical Center
John M Martinez, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth Honsik, MD, Consulting Staff, Department of Primary Care Sports Medicine, Kaiser Permanente
Disclosure: Nothing to disclose.

Medical Editor

Leslie Milne, MD, Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine
Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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