Matthew Hall, DO^a∗ and Jeffrey Anderson, MD, FACSM^b

^aPrimary Care Sports Medicine Fellow, Department of Family Medicine, University of Connecticut, 99 Woodland Street, Hartford, CT 06088, USA. E-mail address: Mahall@stfranciscare.org

^bDivision of Athletics, University of Connecticut, 505 Stadium Road, Unit 3204, Storrs, CT 06269, USA

^∗Corresponding author.

Hip pointers are contusions to the iliac crest and surrounding soft tissue.1,2 They are common injuries in contact sports, such as football, hockey, and rugby, particularly at the elite levels.¹ Despite this, hip and pelvic rim injuries in young athletes have received considerably less attention than injuries to the knee, shoulder, and ankle.¹ Hip pointers can result in significant pain and decreased function affecting athletic performance and result in missed training and game participation. When the injury is recognized and diagnosed early, rapid treatment can allow for immediate return to sport as well as a more rapid return to preinjury status.

Hip pointers, also known in the literature as iliac crest contusions, were first described in the literature in 1966. At that time, it was proposed that hip pointer be used solely to describe a contusion to the iliac crest after direct blow to the area.³ The pathology leading to pain can be subperiosteal edema or bleeding from nutrient vessels of the underlying bone or hematoma formation within the surrounding muscle. A healthy athletic population is also more susceptible due to the minimal amount of soft tissue between the iliac crest and the surface.⁴ Another proposed anatomic explanation for this injury described in the literature is a compression of the abductor muscles against the ilium or iliac crest.⁵

Injuries to the hip and pelvic rim are less common compared with other injuries of the lower extremities, such as the knee and ankle.¹ The exact incidence rate of hip pointers has not been reported in the literature, and further epidemiologic studies are needed to determine the incidence and prevalence in an athletic population. There have been some studies looking at hip pointers and, more generally, hip and pelvic contusions within specific athletic populations.

Studies have shown that injuries to the hip region in high school athletes range from 5% to 9%,⁶ and, therefore, the prevalence of hip pointers can be predicted to be significantly less because this number incorporates all injuries to the hip. An epidemiologic study of hip injuries in National Football League football players between the years 1997 and 2006 reported a total of 738 hip injuries with 33% reported as “contusions.”¹ Hip contusions were the second most common injury behind general muscle strains. Of these hip contusions, 82 were reported as hip pointers, which accounted for 11% of the total hip injuries and 35% of total hip contusions during that time period.¹ The total incidence of hip pointers, when looking at all injuries to National Football League players between 1997 and 2006, was 0.3%. Although the treatment method was not reported in this study, the mean days lost from training was reported as 5.6 days.¹ This is a more significant amount of time missed from training than the authors have seen in their experience or heard about anecdotally.

A retrospective study of Australian football league draftees, spanning 7 years, reported “hip haematoma” as 4% of all injuries to the hip and groin.⁷ It was among the top 10 most common injuries to the hip and groin in their population. The reported incidence in the Australian football cohort was slightly higher than American football, which could be speculated as due to the tackling aspect of the sport plus the lack of protective hip and iliac crest padding in that sport.

Ice hockey is another contact sport where hip pointers are more common. In a cohort of National Collegiate Athletic Association ice hockey players, hip/pelvis contusions have been reported as 2.4% of the total injuries during game play.⁸ Again, the study did not separate out true hip pointers from the group of contusions at the hip and pelvis, making it difficult to state the exact rate of the injury in this particular population.