Disclosures: Prabhav P. Deo, MD: No financial relationships or conflicts of interest

Case Diagnosis: Tensor fascia lata tear following soft tissue atrophy from corticosteroid injection.

Case Description or Program Description: A 41-year-old female former fitness instructor with history of osteopenia presented to an outpatient musculoskeletal clinic with one year of right lateral hip pain. She was previously treated with greater trochanteric (GT) bursa steroid injection, physical therapy including dry needling, offloading with crutches, and tensor fascia lata (TFL) corticosteroid injection without benefit. GT bursa and TFL injections worsened her pain and caused soft tissue atrophy. Physical exam showed profound atrophy of the right lateral hip. Pain was present with right hip flexion and external rotation. There was tenderness to palpation over the right iliac crest, ASIS, gluteal musculature, and GT. FABER reproduced typical hip pain. Pain and weakness were evident with resisted hip abduction in side-lying with the hip in neutral and worse with the hip in extension.

Setting: outpatient musculoskeletal medicine clinic

Assessment/Results: Ultrasound (US) revealed focal hypoechogenicity and thickening of the TFL origin at the iliac crest, consistent with a partial tear. Given lack of progress, patient opted for a platelet rich plasma (PRP) injection into the right TFL origin under US-guidance. 3 mL of leukocyte-reduced PRP was injected into the right TFL tendon origin without complications. Patient returned to clinic 1 month later with significant improvement from the PRP injection.

Discussion (relevance): Local injection of corticosteroid negatively affects tendon cells, results in collagen disorganization and necrosis, and alters mechanical properties. Tendon rupture is the most common adverse event after corticosteroid injection in athletic populations, and is more common after multiple injections to one site. In this case, multiple corticosteroid injections may have predisposed the patient to tearing the TFL origin. Ultimately, PRP was a reasonable treatment option for this patient, which did improve her pain.

Conclusions: Early use of PRP in lieu of corticosteroid injection should be considered for patients with lateral hip tendon partial tears.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/tensor-fascia-lata-tear-following-soft-tissue-atrophy-from-corticosteroid-injection/