eMedicine Specialties > Sports Medicine > Hip
Hip Pointer: Treatment & Medication
Updated: Mar 6, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Acute Phase
Rehabilitation Program
Physical Therapy
Initial therapy of a hip pointer injury consists of ice, anti-inflammatory and pain medication, compression, and relative rest of the affected hip until symptoms improve.5 Crutches can be used in the initial treatment phase if walking or bearing weight on the affected leg is painful.
As the pain decreases, ROM and active resistance exercises for the hip may be initiated. Patients may also begin strength and aerobic conditioning, as tolerated.
Medical Issues/Complications
- The formation of a hematoma, with increasing pain and possible cutaneous neurologic compromise, may be an early complication of a hip point, usually arising within the first 24 hours.
- Additional complications can include development of myositis ossificans. Failure to diagnose a fracture or an intra-abdominal injury frequently leads to complications.
Consultations
- Emergent consultation with an orthopedic surgeon is necessary if neurovascular compromise is considered possible in a patient with a hip pointer.
- Consider consultation with an orthopedic surgeon for patients who have avulsion fractures or unresolved pain lasting longer than 2 weeks.
- Consult with a surgeon for patients with intra-abdominal injuries.
Other Treatment
Aspiration of a hematoma, if present, may provide some pain relief. Injection of a local anesthetic (eg, lidocaine, bupivacaine) may provide short-term pain control.
- No evidence supports or refutes the use of corticosteroid injections in hip pointer injuries.
- Corticosteroid injections may provide relief if greater trochanteric bursitis develops.
Recovery Phase
Rehabilitation Program
Physical Therapy
Rehabilitation programs should focus on returning the athlete back to his or her sport. Rehabilitation exercises should emphasize sport-specific strength and motions. Additional padding at the injury site may help limit recurrence or reinjury (padding that is 0.25-0.5-inch thick may alleviate pain and allow the athlete to return to play sooner).
Maintenance Phase
Rehabilitation Program
Physical Therapy
The maintenance phase of the rehabilitation program should focus upon reducing the chance of reinjury. Additional padding or protection added to the hip may limit the risk of reinjury.
Medication
The goals of pharmacotherapy in patients with hip point injuries are to reduce morbidity and to prevent complications.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action of these agents is not known, but NSAIDs may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may also exist, including inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.
Ibuprofen (Ibuprin, Motrin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Adult
200-400 mg PO q4-6h while symptoms persist; not to exceed 3.2 g/d
Pediatric
<6 months: Not established
6 months to 12 years: 4-10 mg/kg/dose PO tid/qid
>12 years: Administer as in adults.
Coadministration with aspirin increases the risk of inducing serious NSAID-related adverse effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; may increase PT duration when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, or high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in patients with congestive heart failure, hypertension, and decreased renal and hepatic function; caution in the presence of coagulation abnormalities or during anticoagulant therapy
Naproxen (Aleve, Naprelan, Naprosyn, Anaprox)
For the relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.
Adult
500 mg PO followed by 250 mg q6-8h; not to exceed 1.25 g/d
Pediatric
<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d
Coadministration with aspirin increases the risk of inducing serious NSAID-related adverse effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; may increase PT duration when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of the drug.
Ketoprofen (Oruvail, Orudis, Actron)
For the relief of mild to moderate pain and inflammation. Initially, small doses are indicated in small and elderly patients and in those with renal or liver disease. Doses >75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe for response.
Adult
25-50 mg PO q6-8h prn; not to exceed 300 mg/d
Pediatric
<3 months: Not established
3 months to 12 years: 0.1-1 mg/kg PO q6-8h
>12 years: Administer as in adults.
Coadministration with aspirin increases the risk of inducing serious NSAID-related adverse effects; probenecid may increase the concentrations and, possibly, toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; may increase PT duration when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in patients with congestive heart failure, hypertension, and decreased renal and hepatic function; caution in the presence of coagulation abnormalities or during anticoagulant therapy
Analgesics
Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who experience pain.
Acetaminophen (Feverall, Tempra, Aspirin-Free Anacin, Tylenol)
DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, those with upper GI disease, and those taking oral anticoagulants.
Adult
325-650 mg PO q4-6h or 1000 mg tid/qid; not to exceed 4 g/d
Pediatric
<12 years: 10-15 mg/kg/dose PO q4-6h prn; not to exceed 2.6 g/d
>12 years: 325-650 mg PO q4h; not to exceed 5 doses/d
Rifampin can reduce analgesic effects; coadministration with barbiturates, carbamazepine, hydantoins, or isoniazid may increase hepatotoxicity.
Documented hypersensitivity; known G6PD deficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Hepatotoxicity possible in persons with chronic alcoholism after various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; acetaminophen is contained in many OTC products and combined use with these products may result in cumulative acetaminophen doses exceeding the recommended maximum dose
Acetaminophen and codeine (Tylenol #3)
Indicated for the treatment of mild to moderate pain.
Adult
30-60 mg/dose PO q4-6h or 1-2 tab q4h (based on codeine content); not to exceed 4 g/d of acetaminophen
Pediatric
0.5-1 mg/kg/dose PO q4-6h (based on codeine content):
<12 years: 10-15 mg/kg/dose PO (based on acetaminophen content); not to exceed 2.6 g/d of acetaminophen
>12 years: Administer as in adults.
Toxicity of codeine increases with CNS depressants, tricyclic antidepressants, MAOIs, neuromuscular blockers, phenothiazines, and narcotic analgesics; rifampin can reduce the analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase the hepatotoxicity of acetaminophen
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in opiate-dependent patients, because this substitution may result in acute opiate-withdrawal symptoms; caution in the presence of severe renal or hepatic dysfunction; hepatotoxicity with acetaminophen is possible in persons with chronic alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; acetaminophen is contained in many OTC products and combined use with these products may result in cumulative acetaminophen doses and exceed the recommended maximum dose
Hydrocodone and acetaminophen (Vicodin, Lorcet-HD, Lortab, Norcet)
Drug combination indicated for moderate to severe pain.
Adult
1-2 tab or cap PO q4-6h prn
Pediatric
<12 years: 10-15 mg/kg/dose PO q4-6h prn (based on acetaminophen content); not to exceed 2.6 g/d acetaminophen
>12 years: 750 mg PO q4h (based on acetaminophen content); not to exceed 10 mg hydrocodone bitartrate per dose or 5 doses/d
Coadministration with phenothiazines may decrease analgesic effects; toxicity increases with CNS depressants or tricyclic antidepressants
Documented hypersensitivity; high-altitude cerebral edema or elevated intracranial pressure
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Tablets contain metabisulfite, which may cause hypersensitivity; caution in opiate-dependent patients, because this substitution may result in acute opiate-withdrawal symptoms; caution in the presence of severe renal or hepatic dysfunction
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| Overview: Hip Pointer |
| Differential Diagnoses & Workup: Hip Pointer |
 Treatment & Medication: Hip Pointer |
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References
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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
