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Daniel Nelson, MD
Daniel Nelson, MD, Doctor (MD)
Category: Health
Satisfied Customers: 258
Experience:  Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.
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I have had right hip swelling ( pocket like ) with a LITTLE ...

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I have had right hip swelling ( pocket like ) with a LITTLE warmth for five months and have seen 4 doctors and 1 chiropractor. Suggested Bursitis but it is to high for that. Also suggested ITBS in the hip. I have been on Naproxyen, and have had steriod injections with lidocaine in it. I have stopped all excercise for up two months and have done suggested stretches from physical therapy. I also asked if it could be an infection, with a negative response from the doctor. I am at a loss here. Please please help me! I also have had xrays and a mri, with unremarkable results. Only to show benign lymph nodes and phleboliths. Help
Submitted: 6 years ago.
Category: Health
Expert:  Daniel Nelson, MD replied 6 years ago.

Describe the location on the right hip to me as best you can, please. When you say pocket like, can you elaborate on what that means to you? Are you on any medications - names and doses please. Do you have any chronic health problems I should be aware of?

Thank you in advance,
XXXXX XXXXX, MD

Customer: replied 6 years ago.
1 inch below the hip bone, above the bursa (common bursitis area) about 5 inches in length and 1/2 inch in width. Lisinopril 1x day 10 mg. Percocet 7.5/325 every 6 hours for pain for about two months. I had diverticulitis 5 months ago. I am in the army and trying to train for special operations and have stopped traing to let this heal for the last 2 months with no resolve. I dont have much time left to train and also in pain obviously. Pocket like - fattier tissue in that area than the left side
Expert:  Daniel Nelson, MD replied 6 years ago.

The location you are describing is consistent with the tensor fascia lata origin on the iliac crest, laterally. It's origin is above the greater trochanter and trachanteric bursa. It's insertion, the iliotibial band, is on the lateral side of the proximal tibia (the closest portion of the tibia). You mentioned that they examined you for ITBFS, but that is more of a problem at the insertion of the iliotibial band and not the origin of the tensor fascia lata. The images at the Wikipedia link will make sense once you see them.

So they did injections? Where? If they were injecting into the trochanteric bursa, the ITB insertion ... they will miss the tensor fascia lata origin completely. Additionally, MRI generally shows increased signal in ITBFS but not necessarily the fasciitis of the tensor fascia lata origin.

ITBFS is more common among athletes and those in training, for instance SOG, SOCOM, Rangers, SFOD-D, etc.. But it doesn't fit with your circumstances. Diagnostically speaking, just infiltrating lidocaine into the tensor fascia lata origin near the iliac crest down to the lowest level the pain reaches will make it or break it for the diagnosis of tensor fascia lata origin fasciitis. If THAT works, then steroid injections, rest, ice, and later anti-inflammatories, physical therapy (ultrasound with electrical stimulation, iontophoresis, stretches, re-conditioning, strength training, and range of motion), then vigorous training including everything you did before and more. It's a "process."

Recommendations:

  • Tensor Fascia Lata ORIGIN Diagnostic Lidocaine Test
  • If positive ... then therapies as above, preceded by injections of steroid into the TFL ORIGIN, not elsewhere, followed by other modalities.

Thank you for visiting JustAnswer.com's Health Information. I hope that all of your concerns have been addressed and that your experience here was positive and helpful. If you have a new or different question, please don't hesitate to come back or submit a new question. It has been a pleasure helping you. Your FEEDBACK is very important to me.

Kindest Regards,
XXXXX XXXXX, MD

Daniel Nelson, MD, Doctor (MD)
Category: Health
Satisfied Customers: 258
Experience: Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.
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Daniel Nelson, MD
Daniel Nelson, MD
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Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.