A direct blow to the iliac crest, that may contuse the rim of it. Hematoma forms at the point of muscle contact along the iliac crest. This type of injury occurs in football or in other contact sports. Patient examines pain at the time of the injury. He complains of pain at the contusion area during walking.
Physical examination: Pain, swelling and hematoma is seen over the iliac crest. This is not a muscle tear from the crest. So it is important to differentiate from it. Patient is asked to abduct the trunk away from the injured ileum Excruciating pain occurs at muscle tear, less pain and tenderness associated with contusion. X-ray should be taken to rule out iliac crest fracture.
Pathogenesis: Direct contusion to the iliac crest may produce bleeding where the gluteus maximus and medius and external oblique muscles originate from the crest. This bleeding produces a tender hematoma. The bruised iliac crest may or may not cause an immediate pain in the site of the injury. Without first aid a slow internal bleeding will result in swelling and pain after few hours later. This is the reason, why these injuries should be noted and treated early.
Therapy: The treatment consists of ice application and compression over the contusion. Local injection of a long-acting anesthetic agent and hyaluronidaze prevent further hematoma formation. Protective padding should be adjusted to prevent repeated trauma.
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