The Doctor Is In: Steelers LB Vince Williams Might Be Cheering From Sideline Sunday

Pittsburgh Steelers inside linebacker Vince Williams matters.  He leads the defense in sacks this season and trails only his partner Ryan Shazier in tackles.  He plays with passion, and if you follow him on twitter, you probably laughed so hard your drink came out your nose the other day when he was tweeting his tell-all on his teammates.

But when he gets injured, it doesn’t get the kind of media coverage that a skill player like Ben Roethlisberger, Antonio Brown, or Le’Veon Bell commands.  Maybe because it doesn’t affect fantasy football line-ups directly.  Or because outside of Pittsburgh, he doesn’t get the national media enough likes and retweets.  Even the beat reporters are more focused on whether Martavis Bryant really asked for that trade or how much Mike Mitchell got fined, so they haven’t even mentioned if Williams is still using crutches.  Then again, sometimes the team doesn’t permit them to write about what they see in the training facility.  Whatever the reason, there have been no updates on his injury status other than the practice report (DNP for Wednesday and Thursday to date).

All of this is to say that what follows is medical fact but pure speculation as it relates to the injury sustained by Williams on Sunday in Kansas City.  It has been reported as a “hip injury” and a “hip bruise”, but there hasn’t been any other detail provided.  If he had an MRI (and I would assume that he did), no one has talked about it.  So I’m making a few educated guesses here.  Feel free to register your complaints in the comments section below!  OK, here we go…

WHAT COULD VINCE’S INJURY BE?

Let’s look at the film first.  Williams’s last play against the Chiefs, the second play of the 4th Q as the Steelers defense held the Chiefs from scoring in the red zone, was a rushing play to the left by RB Akeen (not Kareem) Hunt.  Williams was blocked by Chiefs TE Demetrius Harris, who used Williams’s momentum to spin him, and they both went down, with Williams landing his right hip.

I’m guessing that Vince has what is often called a “hip pointer”, a type of bone bruise to the top of the hip, which is generally caused by a direct blow or a bad fall.  The other possibility is that Williams has a more superficial contusion, or bruise, meaning that the impact caused bleeding into the soft tissues between the skin and the muscle or within the muscle.

WHAT IS A HIP POINTER?

The hip joint is made up by the pelvis and the femur (long bone of the thigh).  The iliac crest is the upper lateral portion of the pelvis:

www.painfreenyc.com & www.brisbaneservicesguide.com

A hip pointer is a contusion (bruise) of the iliac crest and its surrounding structures, including abdominal wall muscles in that regions such as the transverse and oblique abdominal muscles.  The tensor fascia lata (a muscle that attaches to the iliac crest and inserts on a fibrous attachment called the iliotibial band) and the greater trochanter (see above, the upper part of the femur where some muscles attach).

Hip pointers can be extremely painful, even though there is no actual fracture.

WHAT ABOUT A REGULAR BRUISE?

The other possibility is that Vince had bleeding into the tissues superficial to the bone.  If the blood collects, it will form a hematoma.  This will initially have the consistency of jello, and eventually the body will break it down into liquid form and reabsorb it.  If a hematoma is large enough, it may require a surgical incision to drain the blood out because it would take too long to absorb.  This gentleman isn’t an NFL player, but he did manage to get a hematoma that had to be drained (not my patient):

WHAT IS THE TREATMENT?

As with many soft tissue injuries, it starts with RICE: rest, ice compression and elevation.  Pain is initially managed with Tylenol.  Anti-inflammatory drugs like ibuprofen will also be important once the initial risk of bleeding is over.  Injections with local anesthetic and even steroids can also help with pain management.  You saw that Williams was on crutches when he returned to the sideline during the game.  This was to keep his weight off of his right leg and hip to minimize the pain.  At the end of the game, he reportedly jogged off the field but video also showed him entering the locker room (and exiting when the team left) on crutches.  Good news that he was able to jog but smart of him to then follow the trainer’s advice and keep the weight off his leg to potentially limit the swelling.

While it was never reported, it is very likely that Williams had an MRI Monday to rule out any fractures and assess the extent of soft tissue swelling.

RECOVERY TIME – WHEN WILL VINCE BE BACK ON THE FIELD?

The recovery, as expected, depends on resolution of swelling and pain and there is very low likelihood of long term complications or lingering issues.  Given that Williams hasn’t practiced yet this week (at this time, the injury report for Friday is not yet available), he will likely miss the home game against the Bengals.  There is a very good chance, however, that he will be able to return the following week to face the Lions in their primetime matchup as long as he doesn’t have a labral tear or fracture that we don’t know about.

A study of NFL hip injuries from 1997 to 2006 published in The American Journal of Sports Medicine (BT Feeley et al) found that 82 of 738 hip injuries were hip pointers and the mean loss of training time was 5.6 days.  Chiefs CB Marcus Peters suffered a hip pointer last season and was able to return to play after missing only one game.  Cardinals RB Andre Ellington sustained what was called a “severe” hip pointer in week 13 of the 2014 season and did not play again that year.  Last season, Odell Beckham Jr. had a hip pointer against the Ravens and did not miss a game.

Vince Williams will be missed this week if he isn’t able to go.  But we can at least hope for some hilarious twitter action before and after the game.  And I doubt that this hip injury will slow him down for long.

About the Author

Melanie Friedlander

Melanie Friedlander, MD, FACS, is a board-certified surgeon, who is a passionate Steelers fan and understands injuries from the player’s side, too, thanks to four years of collegiate rugby.

  • falconsaftey43

    Appreciate the very informed speculation as always Melanie!

  • Beaver Falls Hosiery

    Excellent as usual.

  • PapaJuju

    Dirty Red time!

  • nutty32

    Hip pointers are crazy painful. Guess no need to shoot him up and get him back out there at this point of the season.

  • nutty32

    Kind of hoping to see what LJ can do in a real game. Going through non-full speed contact practice with a shoulder shouldn’t be too much of a problem, but it’d be a small miracle if he makes it through a handful of tackles in the game.