Disclosures: Ashley Sanchez, MD: No financial relationships or conflicts of interest

Case Diagnosis: Pigmented villonodular synovitis with superimposed femoroacetabular impingement syndrome of the left hip and athletic pubalgia.

Case Description: A 31-year-old male presented with left anteromedial hip pain and associated anterior lower pelvic pain that started 5 weeks prior while exercising. Upon physical examination, pain was reproduced with left hip passive range of motion, and left intra-articular hip provocative maneuvers. Patient also demonstrated antalgic gait favoring the right leg. Neurological and lumbar examinations were clear. Hip radiograph found mild left hip CAM deformity. Key findings supported initial diagnosis of athletic pubalgia with superimposed femoroacetabular impingement syndrome (FAIS). Given the plateau in physical therapy, left hip magnetic-resonance imaging (MRI) was ordered to assess for muscle or tendon injuries versus other intra-articular pathology.

Setting: Academic sports medicine clinic in a freestanding rehabilitation hospital

Assessment/Results: Left hip MRI showed a moderate hip effusion with a 2.1×1.0x2.7 cm area of nodular synovial thickening eroding the bone at the posterior left formal head/neck junction suggestive of PVNS. The patient was referred to Orthopedic Surgery and underwent left hip arthroscopy for mass resection and labral repair. Post-operatively, the patient tolerated physical therapy with significant improvement in pain and function.

Discussion: Pigmented villonodular synovitis (PVNS) is a rare subtype of tenosynovial giant cell tumors with only 2-8 new cases per million people each year. It presents as chronic mono-articular joint pain and swelling in young adults, most commonly affecting the knee and less commonly the hip. Early diagnosis and treatment are crucial for optimal recovery. However, due to its non-specific presentation, insidious onset and low incidence, diagnosis of PVNS as a cause of hip pain can be challenging and is often delayed.

Conclusion: Although hip pain is classically attributed to common musculoskeletal pathology, we present a unique case of hip pain derived from PVNS with superimposed FAIS and athletic pubalgia.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/unique-presentation-of-pigmented-villonodular-synovitis-of-the-hip-disguised-by-athletic-pubalgia-and-impingement-syndrome-a-case-report/