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CONDITION/DISORDER SYNONYMS

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  • Hip pointer

  • Subcutaneous contusion of the iliac crest

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ICD-9-CM CODE

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  • 924.01 Contusion of hip

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ICD-10-CM CODE

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  • S70.00XA Contusion of unspecified hip, initial encounter

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PREFERRED PRACTICE PATTERN

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation

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PATIENT PRESENTATION

Patient is a 17-year-old high school football player. He was tackled from the right side 1 week ago from a direct blow of the helmet onto the iliac crest. He said he had pain going down his right leg to the knee. He presents with a hematoma at the iliac crest and bruising from the iliac crest down the iliotibial band (ITB). He has a positive Ober test and weakness in hip abduction. He is ambulating with a wide gait pattern and does not like to lay on his right side.

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FIGURE 181-1

Ober test. (From Dutton M. Dutton’s Orthopedic Survival Guide: Managing Common Conditions. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 181-2

Origins of hip pain and dysesthesias. (From Cush JJ, Kavanaugh A, Stein CM. Evaluation of musculoskeletal complaints. In: JJ Cush, Kavanaugh A, Stein CM, eds. Rheumatology: Diagnosis and Therapeutics. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:pp. 3–20, with permission.)

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FIGURE 181-3

(A) Structure of the hip joint. (B) The right hip illustrating the lateral view of the ligaments of the hip joint. (From Morton DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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KEY FEATURES

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Description
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  • Pain along the iliac crest where multiple muscle attachments occur

  • Direct trauma/blow to iliac crest causing immediate pain and debilitation1

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Essentials of Diagnosis
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  • Acute onset from initial trauma

    • Internal muscular bleeding and swelling can/will occur within minutes or hours of the injury

    • Pain radiating into the internal and external oblique muscles

    • Possible paresthesia over anterolateral thigh

    • Acute traumatic event; direct blow to unprotected ilium

    • Subcutaneous contusion, graded I to III

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General Considerations
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  • In younger children, concern must be on a slipped growth plate or avulsion of the iliac apophysis

  • Wearing of a hip pad in sports, to limit contusion

  • Can lead to myositis ossificans2

  • Stress fractures or blood supply disruption to the hip may show up later

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Demographics
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  • Younger, athletic population

  • Can be seen in older ...

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