Iliac Crest Contusion (Hip Pointer)

Topic updated on 09/09/13 8:23pm
  • Mechanism 
    • direct trauma or crushing
    • common in contact sports 
  • Pathoanatomy
    • hematoma occurs into area surrounding iliac wing
      • and can cause bleeding into hip abductor muscles
    • rule out avulsion of the iliac apophysis 
      • in adolescent patients
  • Iliac crest is origin of several muscles any of which can be involved 
    • sartorius 
    • tensor fascia lata 
    • gluteus medius 
    • abdominal muscles
      • transverse or oblique muscles 
  • Symptoms
    • pain near iliac crest
  • Physical exam
    • contusion and hematoma near iliac crest
    • affected hip weakness
    • decreased range of motion
  • Radiographs 
    • usually unremarkable
  • MRI
    • usually unremarkable 
    • can show large hematoma 
  • Nonoperative
    • rest, NSAIDS, steroid injections, and therapy
      • indications
        • main line of treatment
      • technique
        • medications
          • NSAIDs and muscle relaxants may be beneficial
        • therapy
          • focused on stretching the muscles about the iliac crest
          • place affected leg on maximum stretch
        • steroid injections
          • corticosteroid injection directed near iliac crest
        • return to play
          • additional padding during return to play


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Qbank (2 Questions)

(OBQ12.75) A 15-year-old male has the immediate onset of pain during a 100 meter sprint while coming out of the starting blocks and could not complete the race. A pelvis radiograph is shown in Figure A. What is the most appropriate next step in management? Topic Review Topic
FIGURES: A          

1. Skeletal survey, chest CT, and referral to an orthopaedic oncologist for biopsy
2. Open reduction and internal fixation
3. Hip abduction brace immobilization with the hip in 45 degrees of flexion and neutral rotation for 6 weeks
4. Protected weight bearing and activity as tolerated
5. Immobilize in 120 degrees of knee flexion for 24 hours followed by physical therapy

(OBQ06.238) A professional hockey player is checked into the boards and develops a painful hip. He is point tender over the iliac crest. A clinical photo is shown in Figure A. What is the most likely diagnosis? Topic Review Topic
FIGURES: A          

1. Hip flexor strain
2. Hip pointer
3. Apophysitis
4. Piriformis syndrome
5. Trochanteric bursitis



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