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  • Iliac crest contusion
  • 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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Description

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  • Direct trauma/blow to iliac crest causing immediate pain and debilitation1
  • Acute pain and bruising (hematoma) along the iliac crest to the bone and surrounding muscles

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Essentials of Diagnosis

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  • Subcutaneous contusion, graded I to III
  • Acute onset from initial trauma; direct blow to unprotected ilium
    • Internal muscular bleeding and swelling can/will occur within minutes or hours of injury
    • Pain radiating to the internal and external oblique muscles
    • Possible parasthesia over anterolateral thigh

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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
  • Wearing of a hip pad in sports, to limit contusion
  • Can lead to myositis ossificans2

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Demographics

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  • Younger athletic population, direct hot from helmet or fall
  • Can be seen in older adults secondary to a fall or car accident

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Signs/Symptoms

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  • Hematoma1
  • Point tender with palpation over iliac crest and associated muscles
  • Crepitus felt during palpation
  • Muscle spasm noted
  • Pain with AROM hip flexion, hip abduction, trunk rotation, trunk flexion
  • Swelling
  • Redness
  • Ecchymosis, if caused by direct trauma

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Functional Implications

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  • Antalgic gait
  • Painful end ranges during ambulation
  • Decreased weight bearing on the involved side with increased weight bearing on the unaffected extremity
  • Pain and weakness as ITB passes over greater trochanter
  • Pain limiting functional activities (i.e., ADLs, physical and athletic activities)
  • Difficulty sleeping on affected side

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Possible Contributing Causes

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  • Trauma
  • Fall on side
  • Blood thinner medication, increases internal bleeding

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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 disk 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 and/or for fracture
  • Bone scan for stress fracture and hip necrosis
  • Diagnostic ultrasound

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Medication

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  • Limited activity, especially with transition from hip flexion/extension (i.e., 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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