TLJ vs Hip

[Sarah Frunzi]

Last week, I discharged a patient I had been working with for about two and a half months, and this patient case was interesting to me. He presented with anterior hip and groin pain as well as with lateral thigh spasms that were associated with very specific activities. I had several differentials on my list, including maigne syndrome. This was the first case where I experience this presentation and was able to treat it successfully for one region. Initially this differential was only on my radar and decided to treat the hip locally, but after one or two visits with no progress, I transitioned to assessing and treating TL junction. After a few weeks targeting TLJ and working on a home exercise program, this patient’s anterior hip and groin pain completely resolved with return to activity. While I was able to impact the hip/groin complaints significantly, on the other hand, I wasn’t able to make any change in his lateral thigh spasms. Though I am pleased with the progress he made in one area of symptoms, I am frustrated and stumped on not being able to change his symptoms on his lateral thigh. The chronicity of the lateral thigh symptoms was much longer than the onset of anterior hip/groin symptoms and is likely a separate issue. I feel like the patient was overall pleased with his progress regarding the newer onset of groin pain but does believe that Physical Therapy can’t and/or won’t help the lateral thigh symptoms. Knowing that, I think patient expectation will play a large role in this progress regarding those symptoms and continuing with any Physical Therapy sensing a negative expectation with progress wouldn’t be the best at this time. The patient and I discussed seeing his PCP again to discuss further options moving forward. I believe this patient had an overall good experience and even mentioned they would be back to address a shoulder issue in the future. I do feel that I was thorough in my treating and gave adequate time to allow for any change in symptoms, but part of me wonders if I missed something. Should I have a patient like this in the future, I want to ensure that I do a thorough screening and testing of the involved areas to confirm that I have truly ruled out all potential presentations. I know that we can’t always help every single patient or every single diagnosis, but this is an aspect I am still adjusting to as a newer Physical Therapist.

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