Would love feedback if you have seen this or similar.....
15 yr old Fml with sudden onset of hip pain followed by gradual onset of involuntary snapping hip (bil-laterally). Did have ability to snap hip in the past voluntarily but with NO pain (didn't do this often). Snap is now induced EVERY time her heel is lowered on the right leg, with extreme pain and sensation of being locked and needing release (CLUNKS back into position), sometimes the patella moves laterally with pain simultaneously when the hip locks. Stairs, inclines and declines also invoke snap with locking. She has to walk on the toes of her right leg. Left hip also snaps but not as often, also with pain. Pain is 4/10 both in groin, and lateral hips, constant with increase when snap occurs, sometimes after school pain is 7/10. Sports prior to pain (now not doing any sport, only walking at school etc) social horse riding, club netball, school volleyball. Scans: contrast MRI showed signal change in the greater trochanter. Bone scan: clear. Rhumatologist: no features of the benign joint hypermobility syndrome and blood tests -ve (HLA B27-ve). Fluoroscopy during the snapping manouvre demonstrated no true dislocation or obvious subluxation of the hip joint itself with a presumption that the manoeuvre causes significant snapping of the lateral musculotendious structures around the greater trochanter which can be felt clinically. No trochanteric bursitis currently but has had earlier - takes NSAID daily.
Variety of Physios since Feb 2012 with a very dedicated Physio finally found locally who has researched tirelessly to find solutions, we have had a measureable decrease in the height of the heel on the R)leg which is needed to prevent the snapping from occurring - initially measured at 7cm, now 5cm. We are supplementing the Physio exercises (tailored stretching/core strength, trigger point) with another local who specialises in Deep tissue trigger point therapy.
3 Orthopaedic surgeons and the Rhumatologist recommend lengthening or incisional procedures of the iliotibial bands - feeling that our conservative approach has been exhausted, and not effective.
Has anyone seen this to this degree - any advice PLEASE.
Location is in South Australia.
