Contusions of the pelvis, hip joint and upper thigh

Bruise (in Latin contusio) is a closed, that is, not accompanied by a skin wound, damage to tissues and organs without significant disruption of their structure. This means that when a bruise occurs, there are no ruptures or tears of tendons, muscles, ligaments and other soft tissue structures. A bruise may be accompanied by damage to blood vessels, which, in turn, will lead to a hematoma, i.e. a true accumulation of blood in the cavity after an injury or a bruise, when the bruised tissues are evenly saturated with blood. Bruising at the site of the injury usually appears as a blue-purple spot, the color of which gradually changes to greenish and yellow over several weeks. If we talk about bruises of the pelvis, hip joint and upper thigh, the soft tissue over the bony protrusions is most often affected. Most often, a bruise occurs in the area of the greater trochanter of the femur - the most protruding bone formation on the thigh, but a bruise can also occur in the area of the iliac crest, the branch of the pubic bone, the ischial tuberosity, or along the entire anterior outer surface of the thigh.

The cause of the injury is very commonplace - a blow that occurs during a fall, a collision in sports, road accidents, work injuries, etc.

The main complaint is pain at the site of the injury. In this case, the ability to move the leg due to the absence of disruption of the structure of muscles, tendons, and ligaments is preserved, but can be very painful.

Treatment is mainly aimed at relieving pain and maintaining strength and mobility in the joint until symptoms subside. At the same time, it is important to exclude other, more dangerous damage, which we will discuss below.

Possible complications are subfascial hypertension syndrome, myositis ossificans.

Typical bruise sites are located in the area of bony protrusions: front view

Diagnosis

The diagnosis of a contusion of the pelvis, thigh, or hip joint may not be as simple as it seems, since other, outwardly imperceptible injuries can occur during impacts. In any case, first tell your doctor how the injury occurred. After this, the doctor begins the examination. The pain at the site of the bruise intensifies with pressure and tension of nearby muscles. With bruises in the area of the ischial tuberosity, the pain is limited only to the posterior group of thigh muscles, and with bruises of the anterior thigh - to the quadriceps femoris muscle. Since almost all the muscles located here are used when walking, lameness usually occurs. Possible swelling or subcutaneous hemorrhage. Sometimes pain occurs with passive movements of the leg, i.e. not when the patient moves the leg independently, but when the doctor moves the patient’s leg. Passive movements in certain positions stretch the affected soft tissues or adjacent muscles, which leads to increased pain. Thus, bruises in the area of the iliac crest are accompanied by pain with active abduction and passive adduction of the hip, and bruises of the anterior surface of the thigh are manifested by pain with active extension of the leg and flexion of the hip.

Additional diagnostics may be needed to rule out more serious problems. Victims are given x-rays to distinguish bruises from fractures visible on x-rays. First of all, it is necessary to exclude fractures of the femoral head, edges of the acetabulum, fractures of the femoral neck (femoral neck fracture), and trochanteric region.

Of the other radiation diagnostic methods, only magnetic resonance imaging provides valuable information. With its help, it is possible to detect hematoma, Morel-Lavallée syndrome (traumatic detachment of the skin and subcutaneous fat), muscle avulsion, tears of the labrum, stress fracture of the femoral neck and other small fractures missed during radiography. However, magnetic resonance imaging is usually not used immediately, but only when conventional conservative treatment does not give the expected results.

There are no special diagnostic tests for bruises. However, if there is severe swelling, especially in the upper thigh and gluteal region, it is necessary to ensure that subfascial hypertensive syndrome (otherwise known as sheath syndrome) has not developed, that is, that the affected muscles are not pinched in their osteofascial beds. To do this, measure the pressure in these boxes. According to a number of recommendations, increasing subfascial pressure to 30 mm Hg. Art. or to a level of less than 30 mm Hg. Art. Below diastolic blood pressure is an indication for fasciotomy, an operation in which the fascia is cut, which reduces the pressure inside the fascial sheath. Nevertheless, it must be borne in mind that even with such high subfascial pressure, expectant management gives good results in some cases.

Complications

Complications from bruises are rare. One of these complications is the already mentioned subfascial hypertension syndrome, accompanied by muscle fibrosis (gradual replacement by connective tissue) and a decrease in range of motion. Another possible complication is the development of myositis ossificans, a condition in which ossifications form inside the muscles, i.e. areas of calcification, ossification. To prevent myositis ossificans, early mobilization (movement is necessary) of the victim is carried out and measures are taken to prevent the development of hematoma. The resulting hematoma may eventually calcify and become clearly visible on radiographs and CT scans. It is distinguished from soft tissue sarcoma by its x-ray appearance and the presence of previous trauma. Myositis ossificans develops in a centripetal direction: first, a belt of calcifications is formed, which then expands inward. If myositis does not cause complaints, you can ignore it; if it is accompanied by pain or significant restriction of movement in the joints, then the newly formed bone masses are removed surgically after maturation. The maturation of ossifications occurs over several months and is best determined using a special diagnostic method - scintigraphy.

Myositis ossificans. Muscle areas become “ossified” after injury

It is important to mention another important condition, which is not a complication of a bruise, but rather a special form of bruise - Morel-Lavallée syndrome (traumatic detachment of the skin and subcutaneous fat). A separate article on our website is devoted to this syndrome.

Treatment

In the vast majority of cases, bruises of the hip, pelvis and hip joint are successfully treated conservatively, that is, without surgery. The goal of conservative treatment is to restore full range of motion and strength of movement in the injured leg as quickly as possible. Treatment begins with conservative measures to combat pain and swelling. These include rest, cold compresses and non-steroidal anti-inflammatory drugs (Voltaren, Xefocam). If standing or walking causes pain, you can use crutches. After 1-2 days, they begin to restore leg mobility with exercises for passive muscle stretching. You can immediately begin treatment by stretching the affected muscles, for which the leg is immobilized in the appropriate position - for example, if the upper part of the quadriceps muscle is bruised, the knee joint is often fixed in a bent position. Along with stretching the affected muscles, exercises are prescribed to strengthen the surrounding muscles. Gradually, the strength and mobility of the leg is restored, and the victim returns to sports.

Surgical treatment for bruises is usually not required. Only in rare cases is it necessary to open a hematoma or perform a fasciotomy due to increased subfascial pressure.

Severe swelling and failure of conservative treatment indicate a possible large hematoma, preventing the rapid healing of the bruise. In such cases, an MRI is performed and, based on its results, the issue of draining the hematoma is decided.

Forecast

The prognosis for most bruises is favorable, but it is difficult to predict exactly how long it will take to recover from a bruise. It depends on the location and severity of the injury and the characteristics of the body.

Prevention

In young people, bruises inevitably accompany sports, especially such hard sports as American football, hockey or rugby. It is unlikely that they can be completely prevented, but some of them can be avoided with the help of protective equipment. Hockey players, for example, wear special protective shorts that protect the pelvis and hips from injury; American football players also wear similar shorts with built-in protective shields. Other pieces of protective equipment, such as shoulder pads, reduce the likelihood of another player bruising his pelvis and hip when colliding with him. The surface of the playing field may also be an important factor. Thus, there is an opinion (not supported, however, by research data) that when playing on grass, fewer bruises occur than when playing on artificial turf.

In older people, bruises usually occur due to falls. Remove rugs and electrical cords on the floor from areas where you will walk. If it is not possible to remove carpets from the floor, make sure that the corners do not bend. You can apply double-sided tape to the bottom surface of the corner of the carpet. Walk through your apartment or house with your relatives as a “sleuth” or safety specialist: remove or tape the corners of all rugs with double-sided tape so that they are not a tripping hazard. If you have parquet at home, check all its boards so that none of them fall out. If falls happen quite often due to various reasons, then pay special attention to safety. Imagine that a “child” should appear in your house in terms of moving around the apartment: plan it so that there is something to hold on to (but the support should be stable, not a plastic shelf) and there is nothing to trip over. Cover the sharp corners of tables and other furniture with special soft pads (sold in children's stores). Ensure normal lighting in all rooms and corners of your home.

Materials used in preparing this article:

Anderson K et al: Hip and groin injuries in athletes. Am J Sports Med 2001;29(4):521.

Diaz JA et al: Severe quadriceps muscle contusions in athletes. A report of three cases. Am J Sports Med 2003;31(2):289.

The author of the article is Candidate of Medical Sciences Sereda Andrey Petrovich

Symptoms

Symptoms vary in intensity and location. The first symptom of a pelvic contusion is painful pain. This can happen immediately after the injury or within minutes. Depending on the severity and location of the injury, it extends to the entire limb or thigh. After a day, in most cases it is limited to the impact zone on a hard object. Symptoms of bruises also include:

The appearance of bruises. It forms where the impact occurred. After 1-2 days it reaches its maximum size and turns dark blue. Over time it will turn blue and then green.
Swelling of soft tissues. Appears with a hematoma. It is characterized by thickening at the site of injury.
Reduction. It appears as a result of dilation of blood vessels in the skin.
Increased skin temperature at the site of injury.
Movement disorders.

If you fall, the bruise does not appear immediately. It appears gradually and only after some time reaches its maximum size. With light pressure, pain appears and thickening is felt. To reduce the risk of a large bruise, it is recommended to apply a cold compress to the bruised area for 5-10 minutes.

First aid

Recognizing a bruise of the hip joint is not difficult, since the signs of a pelvic injury are specific. If symptoms appear, it is necessary to provide assistance for the bruise.

You need to do the following:

immobilize the area of the damaged joint. The limb should be above the level of the body;
apply a cold compress or ice to the bruised area. Low temperature contributes to the narrowing of blood vessels, preventing blood from flowing out of them and the formation of a hematoma;
change the compress several times (you can leave each one for no more than 20 minutes).

With such symptoms that indicate a bruise of the hip joint, it is necessary to immediately take the victim to a medical facility after providing first aid. This is due to the fact that the victim may experience distortion - sprain of the joint ligaments, or subluxation.

Complications

If left untreated, it can cause complications if the fall causes the pelvis to be severely bruised. These include:

Formation of subcutaneous hematoma. In this case, it is necessary to pierce and remove the contents.
Impacts in the facial bed of the muscle tissue of the thighs and buttocks. This leads to a syndrome accompanied by severe pain and numbness.
Formation of certificates. They arise from intramuscular hematomas and are fossilized muscle fibers. In some cases they require removal.
Traumatic detachment of the epidermis of the hip joint. In medicine, the detachment of the fat and skin layers is called Morel-Lavallee disease.

Repeated bruising eventually leads to osteoarthritis, which is accompanied by pain and loss of mobility.

A pelvic bruise from a fall is one of the most common injuries, especially when playing sports and when there is ice outside. Treatment can be done at home, but if severe pain occurs and the bruise spreads, consult a doctor. This will help avoid complications and loss of mobility.

Treatment of injury

Treatment of a severe bruise of the hip joint is aimed at eliminating the main unpleasant symptoms of the injury and resuming motor activity of the limb. In this case, predominantly conservative methods are used.

Initially, the patient is shown complete rest; the affected leg is immobilized with a splint. Next steps include:

bed rest for a couple of days;
periodic application of cold to the site of injury;
use of antiphlogistic, painkillers, antihistamines;
physical education, which should be carried out already on the 3rd day;
physiotherapy and massage.

Cases with exacerbations are treated in a hospital.

Conservative treatment

When considering how to treat a bruised hip joint, in practice the following drugs are often used:

Antiphlogistic agents. Diclofenac, Ortofen, Voltaren in the form of ointments, injections, and tablets are effective.
Analgesic drugs. The best are Ketorolac, Tempalgin.
Antihistamines for swelling. Claritin, Diazolin, Suprastin.

These drugs help cope with severe pain and eliminate swelling on the first day after injury. Traditional medicine is also often included in the general treatment regimen. As soon as the pain decreases, you can and should begin physical exercise. They help develop the joint, eliminate puffiness and swelling, and strengthen muscle tissue.

Surgery

Surgical treatment of hip joint injury due to a fall is rarely resorted to. Only with secondary progression of infection in the damaged area is surgery performed. Usually two methods are used:

Fluid under the skin on the knee after a bruise or injury: symptoms, first aid and treatment

cutting and cleaning out the hematoma when pus appears;
dissection of the muscle with severe hemorrhages and swelling.

If complications arise in the form of pinched buttock muscles, areas of ossification may appear. They need prompt removal. When soft tissue is detached from the bone outgrowths, a cavity appears that is filled with blood. This cavity also needs to be surgically cleaned and drained.

Use of traditional medicine

For such an injury, treatment at home is possible, but only if it is not severe. Typically, products are used in the form of rubs, compresses, and lotions.

The best recipes are:

Honey and aloe juice . Pass the plant through a meat grinder and squeeze out the healing juice using gauze. Drop a little honey into it and mix well. Moisten a cotton pad in the resulting product and apply to the painful area. Compresses will help quickly eliminate swelling.
Vinegar . To combat hematomas and swelling, use a compress of half a glass of warm apple cider vinegar, to which add a small spoon of salt and a couple of drops of iodine. Soak a gauze bandage in the solution and apply to the bruised area. Ice is placed on top of the bandage and everything is fixed with a bandage.
Cabbage leaves . Take a couple of cabbage leaves, first knead and apply to the bruised area. This method allows you to cope with the acute inflammatory process and pain.
Onion juice . Take an onion, peel and wash it. Then grate and squeeze out the juice using gauze. Dip a cotton swab in the resulting juice and apply to the painful area. The session should be carried out throughout the day, changing the lotion to a new one from time to time.

Folk remedies are quite effective, but to enhance the results they must be included in complex treatment.

Diagnostics

To determine the cause of the injury, the doctor first conducts an examination and reviews the patient's medical history. An external examination reveals most of the symptoms of a bruise; they are also determined by the volume and degree of damage. In addition, it is important for the specialist to determine whether there are problems with the patient’s mobility.

An experienced doctor only needs an external examination of the patient to make a diagnosis and determine the method of therapy. However, to exclude the development of complications and identify more serious injuries, the following diagnostic methods are recommended:

Radiological examination. The image is made in two projections. This allows us to exclude the presence of dislocations and fractures due to bruise of the femur.
CT SCAN. Designed to prevent bone damage. It is also possible to obtain information about inflammatory processes caused by internal bleeding.
MRI. It is considered one of the most informative diagnostic methods. It allows you to assess the condition of joint tissues and hematomas.

Early diagnosis makes it possible to diagnose fractures, dislocations, subluxations and complications of injuries sustained during a pelvic contusion as a result of a fall.

What to do if you are injured

A bruise, if it is mild, can be treated at home.

For hip injury, the following folk remedies are useful:

compresses from fresh cabbage leaves. It must be washed, lightly beaten and applied to the damaged area, secured with a bandage. In the first days after injury, this remedy helps eliminate swelling and relieve pain;
compress with aloe. You need to take an aloe leaf, cut it in the middle, squeeze out the juice. Add a little honey to the resulting juice and mix. Lubricate the damaged area with the resulting mixture and secure with a bandage. Leave for several hours;
mint based ointment. Take 50 g of mint and eucalyptus, chop, add 50 ml of fresh aloe juice. Rub the resulting composition into the injured joint up to 2 times a day.

Prevention

In order not to wonder how to treat a bruised hip joint, it is very important to follow preventive measures. This:

comply with safety regulations at work;
avoid physical overload;
buy only high-quality and comfortable shoes;
use personal protective equipment when working in production or choosing traumatic sports;
look at your feet while moving;
avoid slippery places and uncleared roads;
if necessary, improve living conditions;
comply with traffic rules.

Prevention of complications of injury consists of early implementation of a set of emergency medical measures, taking medications in accordance with the prescription of a specialist.

Risk factors

The causes of injury to this structure are:

falling on one side due to loss of balance. Typically, a hip bruise due to a fall occurs in older people;
a strong blow when the side or upper part of the thigh collides with a hard object;
injury in an accident;
practicing certain sports that are quite dangerous (hockey, football). A bruise occurs when a blow is struck to the pelvis or thighs.

Most often, this type of bruise occurs during sports. At risk are older people who often lose their balance and fall, especially in winter.

Rehabilitation period

After a severe injury to the hip joint, rehabilitation measures are prescribed, during which a number of exercises are performed. In each case, exercise therapy is individual, the following is usually indicated:

Place yourself on your side so that the injured hip is on top. Gently move the limb back. Perform this exercise with extreme caution, without rushing. Repeat 5-6 times.
Starting position: lying on your back. Start making non-sharp circular rotations with the sore limb - first inward, and then outward. Repeat these steps 8 times.
Lean against the wall, resting your healthy side against the wall. Move the injured leg slightly to the side and carefully lift it. Keep your arm straight. Perform exercises 11-12 times.

Performing gymnastic exercises in the first stages of recovery should be strictly under the supervision of the attending physician. This will prevent additional damage. Also, in parallel during rehabilitation, physiotherapeutic procedures such as:

laser therapy;
magnetic therapy;
electrophoresis;
massage.

The purpose of such events is to accelerate restoration processes in the affected structures.