There are several entities that can mimic a lesser trochanter avulsion fracture including Legg-Calve-Perthes disease (LCPD), slipped capital femoral epiphysis (SCFE), snapping hip with the iliofemoral ligament, iliopsoas tendonitis
, referred pain from the gastrointestinal region, and a genito-urologic etiology (1,7,10) Work-up and treatment for these alternative diagnoses are quite different and can lead to unnecessary testing.
Aside from obvious accelerated implant wear and surrounding tissue damage, complications from retained cement are dependent upon the position of the fragment and can include iliopsoas tendonitis
, (2) femoral nerve compression, (3) and groin pain.
The most frequently diagnosed injuries were labral tears, "snapping hip" syndrome (iliopsoas tendonitis
), muscle-tendon strains, stress fractures, and joint disease (e.g., chondral defect, degenerative joint disease).
Among those cases with MRI abnormalities, there were 19 patients with osteitis pubis, 9 with stress fractures (8 with fractures of the inferior pubic ramus), 5 with adductor muscle tears, 6 with hamstring muscle tears, 10 with inflammation of the small rotator muscles of the hip, and 4 with iliopsoas tendonitis
. The remaining 11 patients had various other findings.
Flexion, ABduction, and External Rotation (FABER) can also be used to diagnose iliopsoas tendonitis: The test is positive if it elicits pain in the affected extremity or in the sacroiliac joint on the opposite side.
A patient with quadriceps tendonitis will have much greater pain with resisted hip flexion in the supine position vs the seated position; the opposite is true for a patient with iliopsoas tendonitis. (See "Did you know ...
Nevertheless, the exact cause of iliopsoas tendonitis
often remains inconclusive.