Presentation
60 y overweight and sedentary patient. Generalized hip pain and tenderness . No history of trauma.
Patient Data
Unenhanced MRI coronal plane T1 and STIR shows focal thickening of the proximal iliotibial band and signal alteration around the lower border of the right iliac tubercle ( where the proximal superficial iliotibial band is located ) extending to the adjacent gluteus medius muscular fibers, showing inflammatory changes.
Additionally, signal alteration around the right great trochanter and in the insertion of gluteus minimus and medius is seen, as well as adjacent bursitis , resulting in gluteal tendinopathy with trocantheric bursitis.
Case Discussion
This entity is uncommon.
Usually described in females, young athletes or obese elderly women, as an overuse injury.
They complain about pain and tenderness around the iliac tubercle, located posteroinferiorly to the anterosuperior iliac spine.
Proximal iliac band superficial enthesis is strained, showing signal alteration along the inferior margin of the iliac tubercle , better depicted in T2 /fluid sensitive/STIR sequences. sometimes the enthesis is well seen, thickened. Contrast (Gadolinium) study is not mandatory, but can help to better depict inflammatory changes.
It is possible to see inflammatory changes extend to adjacent structures , such as gluteus medius muscle or tendon, that could contribute with its fibrous structure.
Is important to include the iliac tubercle in the FOV when suspected ,as in many standard hip MRI studies, it is not included and may be missed.