Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Hip pointerSubcutaneous contusion ++ 924.01 Contusion of hip ++ S70.00XA Contusion of unspecified hip, initial encounter ++ 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation ++ Pain along the iliac crest where multiple muscle attachments occurDirect trauma/blow to iliac crest causing immediate pain and debilitation +++ Essentials of Diagnosis ++ Acute onset from initial traumaInternal muscular bleeding and swelling can/will occur within minutes or hours of the injuryPain radiating into the internal and external oblique musclesPossible paresthesia over anterolateral thighAcute traumatic event; direct blow to unprotected ilium +++ General Considerations ++ In younger children, concern must be on a slipped growth plateStress fractures or blood supply disruption to the hip may show up later +++ Demographics ++ Younger, athletic populationCan be seen in older adults secondary to a fall or car accident +++ Signs and Symptoms ++ Point tender with palpation over iliac crest and associated musclesCrepitus felt during palpationMuscle spasm notedPain with active range of motion (AROM) hip flexion, trunk rotation, trunk flexionManual muscle test (MMT): painful with associated musclesSwellingRednessEcchymosis: if caused by direct traumaSensory check of the involved lower leg +++ Functional Implications ++ Antalgic gaitPainful end ranges during ambulationPatient may increase weight bearing on the unaffected extremityPain and weakness as the iliotibial band (ITB) passes over greater trochanterPain limiting functional activities (ADLs, physical and athletic activities)Difficulty sleeping on affected side +++ Possible Contributing Causes ++ Trauma, impactFall on sideTaking a blood thinner medication +++ Differential Diagnosis ++ Ilium fracture, other avulsion fractureIliotibial band syndromeAvascular necrosisSacral iliac dysfunctionGreater trochanteric bursitisLumbar radiculopathyTendinitis of gluteus medius, gluteus maximusSnapping hip syndromeSciaticaFemoral neck stress fractureLumbar disc herniationLumbar degenerative disc diseaseLumbar spinal stenosisHip arthritisSeptic arthritisMetastatic tumorInguinal and femoral herniaHip labral issuePiriformis syndromeMuscle strain (gluteus minimus, internal oblique, external oblique) +++ Imaging ++ Radiographs of iliumRadiographs of spine and hipMRI for soft tissue damage and for fractureBone scan for stress fracture and hip necrosisLeg length assessmentOber’s testDiagnostic ultrasound +++ Medications ++ Corticosteroid injection at the trochanteric bursae, (see Figure B-6)NSAIDs, acetaminophen ++ Orthopeadic Physician for imaging and medications ++ Limited activity, especially with transition from hip flexion/extension (in/out of chair)Unable to sleep secondary to pain with lying on affected sidePainful hip motion limiting ambulation or running ++ Ober testFABRE (Patrick’s test)Straight ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.