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Hip Pointer Treatment & Management

  • Author: John M Martinez, MD; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Oct 22, 2015
 

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.[7] 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

See the list below:

  • 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

See the list below:

  • 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.
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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.[8] 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).

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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.

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Contributor Information and Disclosures
Author

John M Martinez, MD Staff Physician, Kaiser Permanente

John M Martinez, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

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 Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

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.

Acknowledgements

Kenneth Honsik, MD Consulting Staff, Department of Primary Care Sports Medicine, Kaiser Permanente

Disclosure: Nothing to disclose.

References
  1. Winfield C. Common hip injuries. 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. Ardent EA, ed. Orthopaedics Knowledge Update: Sports Medicine 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1999. 281-9.

  4. Hall M, Anderson J. Hip pointers. Clin Sports Med. 2013 Apr. 32(2):325-30. [Medline].

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

  6. Wilson JJ, Furukawa M. Evaluation of the patient with hip pain. Am Fam Physician. 2014 Jan 1. 89 (1):27-34. [Medline]. [Full Text].

  7. Hubbard TJ, Denegar CR. Does Cryotherapy Improve Outcomes With Soft Tissue Injury?. J Athl Train. 2004 Sep. 39(3):278-279. [Medline]. [Full Text].

  8. Serner A, Jakobsen MD, Andersen LL, Hölmich P, Sundstrup E, Thorborg K. EMG evaluation of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries. Br J Sports Med. 2014 Jul. 48 (14):1108-14. [Medline].

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

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

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

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

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

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

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