RICE & MICE: Hip pointers

A hip pointer usually results from a direct blow to either the outside edge of the pelvis (the iliac crest), or the outer aspect of the hip (greater trochanter of the femur) and is an extremely painful injury. The bone and overlying muscle are often bruised, and the pain can be intense and even be felt when, laughing or coughing. Bleeding usually occurs around the front and side of the hip, into the abdominals and gluteus muscles. This bleeding causes swelling and makes movement of the hip very painful. Some players can develop a hematoma, or “pocket of blood” in the soft tissue. Hematoma formation tends to intensify and prolong pain. There is usually less overlying fat and soft tissue over the hip bones and this increases risk for more severe injuries, such as fractures, on impact. In more serious cases of hip pointer a fracture of the bone results.

Symptoms include obvious bruising and swelling, tenderness to touch, range of motion of the hip may be limited, the muscles on the outside of the hip that help to move the legs away from each other. Pain from a hip pointer can last a few days to a few weeks. When a player suffers this type of injury, it will be examined and x rays are often taken of the hip. If a fracture is suspected a CT scan may be obtained. CT scans will also reveal deeper hematomas and bleeding into the pelvis.

The usual treatment protocol for hip pointers starts with RICE; resting and discontinuing workouts; icing the hip for 20 minutes every hour over the first 48 hours; compressing the joints with a tightly wrapped bandage to help prevent swelling; and elevating the joint by sleeping or resting on the opposite hip.  Anti-inflammatory medications may be used and in severe injuries, physical therapy may be used to regain strength and range of motion.

If swelling or hematoma is significant there may be some pressure on one of the nerves that supply sensation to the skin of the thigh. Hematomas may be drained to relieve pain and pressure.  Lidocaine injections to the area may also provide some relief of pain.

While most amateur athletes will be restricted from participation until they are pain free after suffering a hip pointer, most professional athletes will return to play before pain free. This may cause the athlete to compensate for pain or weakness by altering their gait or stride, which in turn, may predispose them to other injuries. When the athlete returns to play, extra padding may be used to protect the area.

Complications of hip pointer injury include: nerve damage if not treated properly, a condition called myositis ossificans (calcification of the muscle), or compartment syndrome. Compartment syndrome is potentially limb and life threatening condition cause by bleeding into a muscle compartment. Muscles are surrounded by thick, dense connective tissue and if bleeding occurs inside the compartment of the muscle, compartment syndrome may occur. If anyone remembers the thigh injury that Jon Kalinski suffered in January 2009, it was from trauma to the thigh that resulted in compartment syndrome. The excessive pressure in the muscle compartment can cause nerve damage, tissue (skin and muscle) death, kidney failure and even death.  Treatment for compartment syndrome is surgical decompression of the compartment where they cut the connective tissue of the involved muscle compartment to relieve the pressure called a fasciotomy. In Kalinski’s case, a 12 inch incision was made to his left thigh and because of the swelling and pressure; the wound was left open for 5 days while the swelling reduced enough to allow the incision to be closed. Compartment syndrome may occur as a result of hip pointers, trauma to muscle from falls, being hit by another player or being hit into the boards as well as trauma from being hit with a stick or puck when blocking a shot.

Not all compartment syndromes are caused by trauma. Sometimes compartment syndrome occurs as a chronic issue and effects the legs or arms. Chronic compartment syndrome is sometimes called exertional compartment syndrome or exercise induced compartment syndrome and treatment can include conservative measures (RICE, massage and myofascial release), though most cases need surgical intervention.

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