What is the cause of hip pointer pain in an athlete with no history of trauma?

From the Guidelines

A hip pointer in an athlete without trauma is unusual and warrants investigation for alternative causes, such as iliac apophysitis, stress fracture, muscle strain, or referred pain from lumbar pathology, as suggested by the lack of direct impact causing contusion to the iliac crest 1. The condition typically results from direct impact causing contusion to the iliac crest, so absence of trauma suggests other diagnoses. Initial management includes:

• Rest
• Ice for 15-20 minutes every 2-3 hours
• Compression with an elastic bandage
• Elevation when possible Pain medication such as ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily with food can help manage discomfort, as per standard pain management protocols 1. Physical examination should assess for:
• Tenderness along the iliac crest
• Range of motion limitations
• Neurological symptoms If pain persists beyond 1-2 weeks despite conservative treatment, imaging is recommended, starting with plain radiographs followed by MRI if necessary, to rule out other causes of hip pain, such as femoroacetabular impingement (FAI) syndrome, dysplasia, and intra-articular pathology (labral tears, chondral damage, and ligamentum teres tears) 1. Athletes should gradually return to activity when they can perform sport-specific movements without pain, typically beginning with low-impact exercises and progressively increasing intensity, to prevent chronic pain or more serious injury 1. This cautious approach is necessary because misdiagnosis or premature return could lead to chronic pain or more serious injury. The use of MRI with or without arthrography can be useful in evaluating labral tears, and high-resolution 3 Tesla (T) MRI may improve the visualization of the acetabular labrum and the hyaline articular cartilage 1. Diagnostic joint injections are safe and useful tools for confirming the etiology of pain, and US can also be used to localize paralabral cysts for aspiration and injection 1.

From the Research

Hip Pointer Pain in Athletes

• Hip pointer pain is typically associated with blunt trauma injury to the iliac crest, resulting in subperiosteal edema, hematoma formation, and bone contusion 2.
• However, in cases where there is no trauma, the cause of hip pain may be attributed to other underlying pathologies, such as intra-articular hip disorders or biomechanical mismatches between the femoral head and the acetabulum 3, 4.

Possible Causes of Hip Pain in Athletes with No Trauma

• Intra-articular hip pathologies, such as acetabular labral tears and femoroacetabular impingement, can cause hip pain and may be difficult to diagnose 5.
• Biomechanical demands of specific sports can also contribute to hip pain, and understanding these demands is important for diagnosis and treatment 3.
• Other possible causes of hip pain in athletes include groin pulls, bursitis, and soft-tissue strains and contusions, which may be related to overuse or repetitive stress injuries 4.

Evaluation and Management of Hip Pain in Athletes

• A thorough evaluation of the athlete's hip pain should include a consideration of their sport-specific biomechanical demands and individual factors, such as kinesthetic deficits, inflexibility, and muscle imbalances 3, 5.
• Conservative management of hip pain may include physical therapy, such as neuromuscular re-education and therapeutic exercise, as well as injection therapy with local anesthetics or corticosteroids 2, 5.