Anterolateral Hip Pain - General Athletics

HISTORY: 39-year-old female presented with five-month history of left anterolateral hip pain, which began after two falls on ice. Immediately after she experienced left hip pain and difficulty weightbearing (WB). She had constant pain worse with WB and pressure from the waistband of clothes. Offloading with crutches, lying in bed, over the counter and narcotic pain medications were helpful. She had been unable to work and had been partial WB for approximately two months before presenting to our clinic. She required assistance from her daughter with activities of daily living due to her pain. She was previously evaluated at an outside facility and was diagnosed with a labral tear based on magnetic resonance imaging (MRI) and was recommended to complete physical therapy and a hip joint corticosteroid injection (CSI). Physical therapy discontinued due to pain and a hip joint CSI provided minimal relief during the anesthetic phase and no therapeutic benefit. She was told nothing further could be done for her. PHYSICAL EXAMINATION: Left hip: Antalgic gait with a crutch. Range of motion limited due to pain. Tenderness to palpation over the anterolateral iliac crest, just distal to the iliac crest, and peritrochanteric. Generalized weakness. Negative Tinel's of the lateral femoral cutaneous nerve (LFCN). Positive FADIR which did not reproduce her typical symptoms. DIFFERENTIAL DIAGNOSIS: 1.Acetabular labral tear2.LFCN neuropathy3.Proximal iliotibial band (PITB) tendinopathy/tearing4.Gluteus minimus/medius tendinopathy/tearing TEST AND RESULTS: Hip and pelvis radiographs: Bilateral crossover signs. Tiny bilateral os acetabuli.MRI: Small non-displaced left acetabular labral tear.Diagnostic Ultrasound: Severe tendinopathy and high-grade partial thickness tearing of the PITB. FINAL WORKING DIAGNOSIS: PITB tendinopathy with high-grade partial thickness tearing TREATMENT AND OUTCOMES: - Anesthetic/CSI of the PITB which gave complete anesthetic, but minimal therapeutic benefit. - Due to ongoing symptoms and limitations, we elected to proceed with ultrasonic tenotomy of the PITB. PROMIS pain interference decreased from 73 to 56 and PROMIS physical function increased from 30 to 47 at 3 months post treatment. She returned to work as a bartender, her social activities and subjectively noted “I have my life back”.