Introduction
Background
A hip pointer is a contusion to the iliac crest, the surrounding soft-tissue structures, or the greater trochanter of the femur. Typically, the injury is caused by a direct blow or fall.1,2,3 Hip pointer injuries occur most commonly in contact sports (eg, football, hockey), but they can also occur in noncontact sports (eg, volleyball) as a result of a fall onto the hip or side. Pain and tenderness in this region can limit an athlete's participation in sports.
For excellent patient education resources, visit eMedicine's Foot, Ankle, Knee, and Hip Center and Sports Injury Center. Also, see eMedicine's patient education article Repetitive Motion Injuries.
Related eMedicine topics:
Femoral Neck Stress and Insufficiency Fractures
Groin Injury
Hip Fracture
Hip Tendonitis and Bursitis
Frequency
United States
No specific statistics for the frequency of hip pointer injuries are available; however, hip injuries generally comprise 5-9% of high school athletic injuries.1,2,3,4
Functional Anatomy
The anterior iliac crest region of the hip and the greater trochanter of the femur have a minimal amount of overlying fatty tissue or muscle and are more susceptible to contusion and injury than more protected regions of the body.
The iliac crest has multiple muscle origins and insertions, including the sartorius, the tensor fascia lata, the internal and external obliques, and a portion of the rectus femoris muscle.
Clinical
History
Obtain a detailed history, including the mechanism of injury and the patient's description of his or her symptoms. A hip pointer is usually an acute injury, and the patient can typically recall a precipitating event, although some may present 24-48 hours after the initial injury.
- Hip pointer injuries are usually caused by a direct blow to the iliac crest or greater trochanter in contact sports such as football or hockey.
- A hip pointer may also be caused by a fall onto the hip in sports such as soccer or skiing.
- Typically, the patient presents with the sudden onset of hip pain in the iliac crest or greater trochanteric region after sustaining trauma.
- The pain is localized and may be exacerbated with activities such as running, jumping, twisting, or bending.
- The pain can limit range of motion (ROM) at the hip joint and/or rotation of the trunk if the abdominal musculature is involved.
Physical
Physical examination in a person with a suspected hip pointer should include abdominal examination to exclude trauma to intra-abdominal organs. Examination should consist of visual inspection, palpation, passive and active ROM assessment, sensory testing, and gait analysis.
- Contusion or swelling may be evident upon visual inspection. The athlete usually reports increased pain with palpation of the affected iliac crest or greater trochanter. Limited ROM of the hip secondary to pain may also occur.
- Motor strength of the hip flexor and extensors should be intact. Strength of the hip abductors and external rotators may be limited by pain if the contusion includes the sartorius muscle and/or the iliotibial tract.
- Sensation should be intact to light touch, although this portion of the examination may be limited if the patient has severe pain.
- Initial gait analysis may also be limited secondary to pain, but it provides a baseline from which to evaluate recovery.
Causes
- The primary cause of hip pointers is a direct blow or fall onto the iliac crest or greater trochanter.
- Risk factors include participation in contact sports and wearing limited or no padding or protective equipment in the region.
More on Hip Pointer |
 Overview: Hip Pointer |
| Differential Diagnoses & Workup: Hip Pointer |
| Treatment & Medication: Hip Pointer |
| Follow-up: Hip Pointer |
| References |
| Next Page » |
References
Winfield C. Common hip injuries. In: Sallis RE, Massimino, eds. ACSM's Essentials of Sports Medicine. St. Louis, Mo: Mosby; 1991:440-1.
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].
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.
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].
Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury?. J Athl Train. Sep 2004;39(3):278-9. [Medline]. [Full Text].
Adkins SB 3rd, Figler RA. Hip pain in athletes. Am Fam Physician. Apr 1 2000;61(7):2109-18. [Medline]. [Full Text].
Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. Jul-Aug 2001;29(4):521-33. [Medline].
DeLee JC, Farney WC. Incidence of injury in Texas high school football. Am J Sports Med. Sep-Oct 1992;20(5):575-80. [Medline].
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].
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].
Schmitt KU, Nusser M, Boesiger P. [Hip injuries in professional and amateur soccer goalkeepers] [German]. Sportverletz Sportschaden. Sep 2008;22(3):159-63. [Medline].
Further Reading
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
