1017 - Case Report: Proximal Tensor Fascia Latae Injury in an Adult Soccer Player

Case Diagnosis: Proximal TFL partial tear Injury

Case Description: 42-year-old male with a history of ankylosing spondylitis and Crohn's disease presents with acute left lateral buttock pain. The pain initiated during a soccer game, accompanied by an audible pop. On physical examination, tenderness and a palpable defect were evident over the lateral aspect of the left hip. Active hip abduction and internal rotation elicited limited motion and discomfort. Weakness in leg abduction and external rotation. Radiographs revealed no bone pathology or avulsion fractures. MRI unveiled a left proximal TFL avulsion involving 50% of the muscle, longitudinal split tear in the iliotibial band, and large multi-layered hematoma. The patient underwent conservative management: compression with two weeks of limited activity outside of walking, non-steroidal anti-inflammatory drugs (NSAIDs), and then aggressive eccentric based exercises. Physical therapy aimed at pain control, strengthening the hip abductor muscles, and gradual return to functional activities. Able to resume sports at 12 weeks.

Discussions: Proximal TFL tears are infrequent in adults, typically associated with acute trauma or forceful TFL muscle contraction in youth with open growth plates. Limited literature regarding adult treatment options and outcomes. This case presents a unique scenario with 50% of the tendon still attached, strength of 4/5 of muscle. Treatment followed a similar approach to a partial hamstring tear. Timely diagnosis, hematoma management, and temporary sports cessation played vital roles in recovery. This demonstrates that a non-surgical approach to this injury should be attempted prior to surgical escalation.

Conclusions: Proximal TFL partial tears in an adult is a rare cause of lateral buttock pain. This case underscores the significance of clinical assessment, imaging, and a multidisciplinary treatment approach. Timely recognition, conservative measures, and focused rehabilitation can yield favorable results, empower athletes to return to their pre-injury activity levels. Further research is necessary to enhance diagnostic techniques and optimize treatment strategies.