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The pelvis is a large broad structure that connects to the base of the spine and creates the origin for the lower limb. Two large Iliac bones connect to the Sacrum forming the Sacroiliac Joint. Within the large and sweeping Iliac bones, there are two articular surfaces for the ball of the femur or upper thigh bone. The outer aspect of the femur is called the greater trochanter and it is the widest portion of the upper leg before the lip of the pelvis.

Soft tissue injuries in this region are most often traumatic due to the lack of overlying soft tissue. A direct blow or impact to the Iliac Crest or Greater Trochanter are referred to as Hip Pointer Injuries (HPI). These injuries result in immediate and extensive bruising or bleeding post-injury, called a contusion. The degree that surrounding soft tissue structures such as Gluteus Minimus, Tensor Fascia Latae, Sartorius and the Abdominals are involved is determined by the severity of the impact.

This mechanism is most likely to occur during sports, motor vehicle accidents or heavy falls. The sports most commonly associated with HPI include hockey, football and rugby due to the prevalence of impact of equipment or heavy tackles resulting in a fall. With consideration of other sports related injuries, the prevalence of HPI is still less than 1%.

Symptoms:

  • Bruising over the side of the hip, pelvis and upper lateral thigh
  • Associated swelling over the area
  • Pain with hip movement and walking
  • Reduced hip range of motion
  • Weakness of the surrounding musculature

Diagnosis:

HPI is diagnosed through a thorough history taking and objective exam to assess hip range of motion, strength, swelling and tissue integrity. Your Physiotherapist will rule out differential diagnoses such as fractures, hip dislocation, myositis ossificans, avulsions, exertional compartment syndrome, slipped capital femoral epiphysis or other musculoskeletal conditions involving the anterolateral hip.

Imaging such as X-ray, CT or MRI may be utilised if there are concerns around bone stress injuries or fractures present. In HPI the only finding on imaging will be the presence of swelling to indicate soft tissue injury.

Management:

As HPI are acute, management is similar to that of soft tissue injuries. This would include compression, icing, weight-bearing as tolerated and the use of pharmacological agents for pain management as required. In some instances, aspiration of the haematoma may be completed however this will be guided by your GP or Sports Physician. If there has been an injury to the bone, there will be a specified period of non-weight bearing and graded return to loading.

You Physiotherapist will progressively increase muscle and bone load through a graded strengthening program as pain reduces. A sport-specific rehabilitation plan will be completed to ensure that the period of reduced weight bearing and tissue healing does not predispose the affected limb to further injury.