(AVUSLION OF ASIS)
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What is a Hip Pointer ?
A hip pointer is a common injury in athletes and typically occurs during the first steps of a high school sprinter. It is a type of tendon avulsion injury that occurs in teenagers.
Lets explain what an avulsion injury is.
Our muscles originate on one bone and then attach to another bone. The muscle itself looks like a steak, but it turns into a thick yellow band (called a tendon) where it originates and attaches to bone. A tendon is very strong, think of a really thick root of a plant. If you are pulling out a weed, sometimes the plant rips in the middle, but many times it complete pulls out of the ground from its roots (the roots or stem doesnt tear because its really strong). An avulsion injury is really a type of torn tendon. It occurs when the muscle tendons are so strong that you will not tear a tendon but rather rip off the tendon off the bone. Many times you actually see a piece of bone pulled off too on the x-ray (like all the soil contained within the roots when you pull out a weed).
This is the best way to understand a HIP POINTER. It is a tendon avulsion off the ASIS (pointy part on the front of your pelvis...ASIS is an abbreviation for anterior superior iliac spine ). There are two tendons (the Tensor Fascia Lata and the Sartorius) that originate on the ASIS.
During a sprint, if these muscles are really tight or if they experience too much force, they will rip right off the bone like pulling a weed out of the ground.
How is a Hip Pointer diagnosed?
A Hip Pointer is suspected based on the story of the injury. The major symptom is hip pain right at the bony part of your pelvis. They also have pain lifting their foot off the ground because the torn tendons help with hip flexion....lifting your foot off the ground is hip flexion.
Its important to rule out other similar injuries and therefore X-rays are recommended. They often show a small chunk of bone that is pulled off with the tendon. If its the TFL tendon that is avulsed...there is usually a larger chunck of bone, and its pulled to the side. If its the sartorius tendon thats avulsed, there is usually a small piece (or no piece) of bone.
MRIs are rarely needed.
How is a Hip Pointer treated?
Treatment of a Hip Pointer is rest. Luckily this tendon injury does not require surgery
Kids with this injury should use crutches for a few weeks until the hip feels better and then slowly return to sports once the pain has fully gone away.
What is the long term outcome?
The good news is that the vast majority of people heal after a few weeks without any significant long term effects.
The tendons that are avulsed are for muscles that are not the most important for hip flexion and knee extension (your QUAD muscles are the most important for that), and therefore, once they heal, few athletes notice any changes in strength.
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1. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Rossi F, Dragoni S
Skeletal Radiol.. 2001 Mar;30(3):127-31.