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  • Hip pointer
  • Subcutaneous contusion

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  • 924.01 Contusion of hip

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

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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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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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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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Medications

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  • Orthopeadic Physician for imaging and medications

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  • Limited activity, especially with transition from hip flexion/extension (in/out of chair)
  • Unable to sleep secondary to pain with lying on affected side
  • Painful hip motion limiting ambulation or running

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  • Rest, non-weight bearing
  • ...

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