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Condition/Disorder Synonyms

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  • Hip pointer

  • Subcutaneous contusion

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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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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 debilitation

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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

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General Considerations

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  • In younger children, concern must be on a slipped growth plate

  • 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 adults secondary to a fall or car accident

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Clinical Findings

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Signs and Symptoms

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  • Point tender with palpation over iliac crest and associated muscles

  • Crepitus felt during palpation

  • Muscle spasm noted

  • Pain with active range of motion (AROM) hip flexion, trunk rotation, trunk flexion

  • Manual muscle test (MMT): painful with associated muscles

  • Swelling

  • Redness

  • Ecchymosis: if caused by direct trauma

  • Sensory check of the involved lower leg

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Functional Implications

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  • Antalgic gait

  • Painful end ranges during ambulation

  • Patient may increase weight bearing on the unaffected extremity

  • Pain and weakness as the iliotibial band (ITB) passes over greater trochanter

  • Pain limiting functional activities (ADLs, physical and athletic activities)

  • Difficulty sleeping on affected side

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Possible Contributing Causes

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  • Trauma, impact

  • Fall on side

  • Taking a blood thinner medication

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Differential Diagnosis

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  • Ilium fracture, other avulsion fracture

  • Iliotibial band syndrome

  • Avascular necrosis

  • Sacral iliac dysfunction

  • Greater trochanteric bursitis

  • Lumbar radiculopathy

  • Tendinitis of gluteus medius, gluteus maximus

  • Snapping hip syndrome

  • Sciatica

  • Femoral neck stress fracture

  • Lumbar disc herniation

  • Lumbar degenerative disc disease

  • Lumbar spinal stenosis

  • Hip arthritis

  • Septic arthritis

  • Metastatic tumor

  • Inguinal and femoral hernia

  • Hip labral issue

  • Piriformis syndrome

  • Muscle strain (gluteus minimus, internal oblique, external oblique)

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Means of Confirmation or Diagnosis

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Imaging

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  • Radiographs of ilium

  • Radiographs of spine and hip

  • MRI for soft tissue damage and for fracture

  • Bone scan for stress fracture and hip necrosis

  • Leg length assessment

  • Ober's test

  • Diagnostic ultrasound

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Treatment

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Medications

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  • Corticosteroid injection at the trochanteric bursae, (see Figure B-6)

  • NSAIDs, acetaminophen

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Referrals/Admittance

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