This 39-year-old female presents with hip pain that has continued for four months. Neither a cortisone shot, nor physical therapy could relieve the pain. Have a look at coronal images 1 and 2.
Q1 – What is the most likely diagnosis?
Q2 – Is this entity more common in males or females?
Coronal STIR
Coronal STIR
A1 – The most likely diagnosis is proximal iliotibial band (ITB) syndrome.
A2 – Proximal ITB is more common in females.
Proximal ITB syndrome is related to a strain or injury of the iliotibial band enthesis where the ITB attaches to the iliac tubercle. This entity is newly described by Sher et al. in 2011*, with few reports currently existing in literature. As such, little is known about the cause or treatment options.
To date, most results suggest there is a strong female predisposition; some of which are active runners. Others are non-athletic, some of which have a prior traumatic injury. Most commonly, patients are middle aged.
In magnetic resonance imaging, proximal ITB syndrome presents as areas of increased signal intensity adjacent to the iliac tubercle. Partial or complete disruption of the ITB may occur. The appropriate therapy is unknown. It is likely conservative for most patients.
*Reference: Sher I, Umans H, Downie SA, Tobin K, Arora R, Olson TR. Proximal iliotibial band syndrome: what is it and where is it? Skeletal radiology. 2011;40(12):1553-6.
Check out MRI Online for more case review.
If you enjoyed this case, you may also enjoy:
Can you see why this patient has muscular pain and swelling?
What is the diagnosis for this former pro athlete with hip and groin pain?
Can you pass the test in analyzing this athlete’s thigh injury?
Dr. Stephen Pomeranz
Dr. Robert Wissman
