Disclosures: Ryan C. Hafner, MD: Nothing to disclose

Case Description: The patient, with known hEDS, presented with worsening chronic left hip pain. Initial work-up noted arthritic changes via x-ray and iliopsoas bursitis via MRI, which were treated with PT for core, hip girdle, and pelvic floor stabilization. Upon follow-up, the patient noted intermittent dysuria and urgency along with position-dependent sharp left groin and thigh pain that worsened with sit-to-stand and bending maneuvers.

Setting: Outpatient Sports & Musculoskeletal Clinic

Patient: 70-year old female with hypermobile Ehlers-Danlos syndrome (hEDS).

Assessment/Results: Diagnostic ultrasound of the left hip showed an abnormally large left anterior hip synovial cyst extending retrograde through the femoral triangle into the abdomen, a unique progression likely attributed to the hEDS variant. This was further confirmed with repeat MRI. The cyst was localized from the articular hip to both the femoral and inguinal canals as well as 3 cm from the patient’s empty bladder.

Discussion: Patients with hEDS are more susceptible to joint pathology. Synovial cysts located in the hip are less common than in other joints with no gold standard of treatment. The cyst’s proximity to the bladder was proposed to explain the urinary symptoms, given that a full bladder might interact with the cyst and induce spasms. Proximity to the femoral canal and impingement on the femoral nerve was proposed to explain the transient neuropathy. As providers expected, both symptoms were temporarily relieved with aspiration and steroid injection with results lasting up to 6 months until the cyst would ultimately refill. Given the refractory results and concern for excessive intra-articular steroid use in an already degenerative joint, the treatment team is contemplating minimally invasive bursectomy or sclerosing agent.

Conclusion: Synovial cysts in patients with connective tissue disorders such as hEDS can evolve erratically to impinge on other nearby structures. Treatment should be individualized based on imaging findings and associated symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/unilateral-retrograde-hip-synovial-cyst-in-hypermobile-ehlers-danlos-syndrome-causing-neuropathy-and-bladder-dysfunction-a-case-report/