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.

Hip pointer.  5 things to know about an iliac crest contusion

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
Fortunately a hip pointer is not a serious medical issue and represents more of a bruise to the ego than anything else.  What thoughts or comments do you have?


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