Boyd W. Haynes III, MD I’m a Fellowship-trained Sports Medicine physician and I regularly treat athletes who are injured while playing the sports they love. Each sport has its own “lingo” and sports medicine has its own lingo as well. If you are an athlete, you may have heard the terms “stinger”, “zinger” or “burner” and know that each refers to an injury to the neck and shoulder that causes pain and weakness in the upper extremity. A “hip pointer” is an injury commonly occurring in sports that is frequently after a hard fall or direct hit during a contact sport. In this article, I’ll give you all the information you need to know about this injury, its symptoms, diagnosis, treatment, recovery and what to do if things don’t go according to plan.
Often, a picture is worth a thousand words. In this image, we are looking at a human spine, iliac crest and pelvis, including the hip and femur bone. If you notice the red starbursts that are highlighted in the image, the one at the top is the iliac crest and the one at the bottom is the femoral head. Both areas of bony prominence are prone to injury when hit directly or if impacted by a hard fall. You can see the points of the bones; hence “hip pointers”. Clever, huh? Think about falling hard on the ice while playing hockey or getting hit by someone’s football helmet in the hip during a tackle on the field. Youch!
Symptoms of a hip pointer can be minor to severe. Pain, bruising, swelling, tenderness, soreness, limited range of motion in the hip, weakness in the hip and leg and even difficulty walking are common. In the more severe cases, a large bruise or hematoma (a collection of blood) can form, causing pressure on nerves to the leg, causing excruciating pain.
Diagnosis of a hip pointer begins with x-rays, and a thorough physical examination in my office. I’m going to ask how the injury occurred, what symptoms you have experienced, if you have tried to treat the symptoms at home, if anything you have tried has helped, etc. If the patient has a massive hematoma, I may do a needle aspiration to drain the blood off to relieve pressure on the nerve(s) and help it heal more quickly. I may also suggest the use of crutches for a week or two while the athlete heals. I typically will send the patient home for several days of rest, elevation of the leg with intermittent ice packs for 48 hours (or longer) and the use of naproxen sodium, a strong anti-inflammatory for one-two weeks.
The use of steroids can be helpful; however it is recommended not to inject the area until the bleeding has completely stopped to prevent any disordered muscle healing. I will decide on the use of steroids on a case-by-case basis with each athlete.
Physical Therapy is also useful and will be started as soon as possible, especially for the reduction of inflammation and to regain range of motion. As healing increases, we will increase therapy to include strengthening as well. Full recovery from a hip pointer typically takes two to four weeks.
If the patient does not recuperate within the normal time frame, I will order an MR scan to get a better understanding of what is going on. There may be a hairline fracture that was not visible on x-ray or some kind of soft tissue injury that is hampering a return to activity that warrants further investigation.