I saw a patient who was brought in by his mother concerned after a soccer collision. He could barely walk. When I examined him, he was very tender over the outside aspect of his pelvis.
The x-rays fortunately did not show a fracture. His diagnosis was a hip pointer injury. He recovered over the next 4 weeks and returned to soccer. I wanted to go over the major aspects of hip pointer injury you should know. Here are 6 answers to common questions asked in the office.
- What is a hip pointer injury? A hip pointer injury is a bruise or contusion of the iliac crest. The iliac crest is the major bone in your pelvis. I have included a link to the anatomy of the iliac crest. There isn’t an obvious fracture on x-ray, but there is bruising directly over the bone.
- What are the symptoms of a hip pointer? Because it is a bruise over the hip bone, walking can be difficult. This is because the hip muscles are directly over the bruise. Sometimes the bruise can be a bleed or hematoma which will appear on the surface of the skin over the pelvis.
- Should I see a doctor for a hip pointer? It really depends. If you can walk off the field after a collision that is a good sign. Same thing goes for someone who trips and falls. A good test is how easily you can “walk it off.” I watch my kid’s soccer games on the weekend. At most games a child will get knocked down. I don’t go out on the field unless the child simply can’t get up because of significant pain. Fortunately the player walks off the field on their own power. That is a good functional test of how serious an injury is or is not.
- How do you make a diagnosis in the office? The first thing I do is take a medical history. Usually there is a story of diving for a ball in a sport or a collision at home plate. Sometimes it is more entertaining like walking into a screen door that was closed by the spouse. I then ask the patient to walk for me in the office. Just observing someone walk gives me a lot of information. I look for a limp or favoring of the affected side. I then proceed to look at the area where the pain is located. There may or may not be a bruise. I will test the strength over the hip muscles particularly the abductors of the hip. An x-ray in the office will tell me if there is an obvious fracture.
- Do I need an MRI? Sometimes an MRI is helpful. I always ask myself, “Will ordering an MRI change my treatment?” If the answer is no, then I typically don’t order the MRI. If I am concerned about a more serious injury, I will order an MRI. One example occurs in young adults. This is when a major muscle pulls entirely off the bone. This is called an avulsion fracture. Here is a link for this topic.
- What is the treatment? I treat hip pointers by allowing the hip to heal naturally. This involves protecting the hip from further injury. For kids in sports, that entails no soccer or basketball for 2-4 weeks. I also encourage ice over the area when the injury is more recent to help with swelling and pain. I typically don’t send people to physical therapy unless there is weakness in the hip that doesn’t improve with time.