Causes / typical injury mechanism: Iliac crest contusion, also known as a hip pointer, is a relatively uncommon condition characterized by hematoma of the area surrounding the iliac crest caused by blunt trauma. It is most commonly experienced by athletes participating in contact sports such as football, hockey, basketball, and rugby, but it also can be as a result of motor vehicle crashes.

Classic history and presentation: The condition presents with significant pain over the iliac crest region after direct trauma. Ecchymosis / swelling / fluctuance may be present, and a hematoma may be palpable. Affected patients may display an antalgic gait.

Prevalence: The incidence of hip pointers in the general or athletic population has not been specifically studied. Injuries about the hip account for 5%-10% of all athletic injuries, of which hip pointers only account for a small percentage.

Risk factors: Risk factors include participating in contact sports, taking anticoagulant / antiplatelet medications, and blood clotting disorders such as hemophilia and von Willebrand disease.

Pathophysiology: Hip pointers are caused by direct blunt trauma to the region of the iliac crest. There are no major blood vessels overlying the iliac crest (a relatively superficial structure), so if a hematoma develops, it is from disruption to surrounding musculature or smaller penetrating vessels. Many muscles originate or attach on or near the iliac crest and can be affected, depending on the severity of the injury, including gluteus medius, sartorius, tensor fascia latae, transversus abdominus, and the internal / external oblique muscles, iliacus, quadratus lumborum, and a portion of latissimus dorsi.