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What's the deal lateral hip pain?

Exit forum ID Forum Discussion What's the deal lateral hip pain?

This topic contains 0 replies, has 1 voice, and was last updated by   Brandon Cohen DC, CSCS August 31, 2019 at 2:01 pm.

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    Brandon Cohen DC, CSCS

      What are the most common causes of lateral hip, and only lateral hip pain. Not anterior and lateral, not anterior, posterior and lateral, but lateral hip. Pain in the superior aspect of the lateral hip, superior to the greater trochanter and inferior to the iliac crest. In the TFL area.

      Okay, here’s some information.
      Age: 40
      Sex: F
      Location: left lateral hip and left-sided lower lumbar spine (I know what you’re thinking, but these are separate complaints with separate diagnosis…I hope it comes together. She was previously treated for a similar lumbar spine complaint)
      Quality: Sharp with provocative factors, achy
      Intensity: Current 3/10, avg. 5/10, worst 7/10
      Provocative: Weight-bearing after sitting or driving for 10 minutes. After general activity, direct pressure. (Pain episodes are more frequent with more activity including running and hiking)
      Palliative: inactivity

      Pain has been present for 5 months post tough mudder, gradually getting worse until about 3 weeks ago when she stopped exercise.
      SLR: 90B no sx
      SHF: Thigh to ribs B. mild ant hip pinch on the left.
      QLF: 80% no sx
      KHE: 100% + no sx
      SLPF: 100% post thigh stretch.

      Lunge test: positive adduction on L
      TFL stretch (sidelying with affected side up): moderate lateral hip tension
      TFL strength (sidelying with affected side up, resisted tension): painful in the area of CC.

      Adhesions: Adductor Magnus 1
      Posterior hip capsule 1
      Lateral femoral cutaneous nerve at lateral hip at TFL 3
      Distal IT band 1

      Dx: 1. lateral femoral cutaneuos nerve entrapment at TFL.
      2. hip joint pathology/tendinosis to the lateral hip
      3. hamstring weakness

      Her lumbar spine complaint was a cluneal nerve entrapment and has been resolved. Lateral hip pain is 20% better after treatments. The nerve and the area around the nerve moves better, but still feels quite restricted, which is part of the reason I am considering tendinosis in the lateral glutes. Palpation to the opposite side does not produce the same symptoms. We have been doing hip lifts and started an eccentric exercise for the lateral hip, lunge is getting better. Up until writing this out, imaging did not seem necessary. Last visit she reports feeling 5/10 pain at worst.

      Could hip joint pathology manifest as lateral hip pain with this information? How bad does a tendinosis need to be to show up on MR?

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