Hip Contusion

Anatomy

The anatomy of the pelvis is somewhat complicated and is beyond the scope of this book. Suffice to say, hip contusions can occur when the bony prominences in this area are injured, including the iliac crest, pubic rami, greater trochanter, and ischial tuberosity (Figure 1). The soft tissues in this area are often injured as well, and hemorrhage can occur into the muscle. This hemorrhage may occur almost instantaneously or slowly. If the bleeding into the muscle occurs at a slower rate, the athlete's symptoms and pain may actually worsen 1 day or so after the injury occurs.

Figure 1 Hip Anatomy

History and Physical Exam

A detailed history should be obtained from any athlete complaining of hip pain. This should include the mechanism of injury and a description of the symptoms that the athlete is experiencing. Typically, the athlete can recall the exact injury, and often, the onset of pain is sudden. Activities that stress the area, including running, jumping, or simply walking, can increase the hip pain.

On physical exam, there may be an obvious area of swelling or contusion. The affected area is often very tender. The active and passive range of motion of the hip and nearby joints should be tested. Often, the range of motion of the hip will be limited by pain. The motor strength of these areas should also be tested, and motor strength should be near normal. Specifically, the hip flexors, extensors, abductors, and adductors, as well as the knee flexors and extensors, should be tested. The hip abductor and the external-rotation strength may be slightly decreased due to contusions in these areas. Sensation should be tested as well and should be symmetrical bilaterally to light touch.

Treatment

Early treatment during the acute phase of hip contusions consists of the RICE protocol—rest, ice, compression, and elevation. The aim of these treatments is to control and decrease deep bleeding into the tissues. Anti-inflammatory medications such as ibuprofen, naproxyn, or ibuprogen can provide relief, but giving these too early may increase the amount of bleeding into the tissues. Heat, massage, and physical therapy should not be started for the first 48 hours because they may also increase the bleeding. In adults, after a fracture has been ruled out, local corticosteroids can be injected into the area, which may ultimately help alleviate pain in this area and allow athletes to return to sports quicker. As the pain decreases, passive range-of-motion and then active range-of-motion hip exercises can be started.

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