1409 - Chronic hip pain to hip hip hurray! A case report.

A 16-year-old female presented to sports medicine clinic with a 1.5 year history of right lateral thigh pain extending past her lateral knee, right leg weakness, and imbalance requiring assistance of a cane for ambulation. She was a dancer but symptoms limited her tolerance to  3 hours of rehearsal twice a week. She was previously evaluated by outpatient neurology with unremarkable findings on EEG and a right hip MRI. On examination, we noted weakness of the right hip abductor, right greater trochanter and IT band tenderness, antalgic gait, positive right Trendelenberg, and dynamic valgus on right leg squat. She was diagnosed with right greater trochanteric pain syndrome and right IT band syndrome. 

Discussions:

Ultrasound revealed subgluteus medius bursitis and tendinosis of gluteus medius and minimus. Ultrasound-guided right subgluteus medius bursa steroid injection and right proximal IT band trigger point injection were administered. She was provided a script for physical therapy sessions which she completed. On follow-up, her pain had completely resolved, her gait was improved, and she was able to tolerate 8-hour ballet rehearsals. 

Greater trochanteric pain syndrome and IT band syndrome are clinical diagnoses. Although iliotibial band thickening, abductor tears, or other tendon abnormalities may be present on MRI, our patient’s imaging studies were unremarkable. Given this, her diagnosis required a combination of thorough history-taking, physical examination, and the use of point-of-care ultrasound for dynamic evaluation.

Conclusions:

Pain syndromes such as Greater Trochanteric Pain Syndrome and IT band syndrome require a skilled clinical approach to diagnosis and management, particularly when imaging findings are non-contributory. The resolution of our patient’s long-standing right lower extremity pain and weakness speaks to the importance of physiatry in the treatment of these disorders.