Iliopsoas Tendinitis

What a way to learn anatomy!

The iliac spine is not part of the spine.  It’s where the thigh and pelvis are held together by tendons (I think).  (see sketch here).  Without an injury, it’s pretty unusual for a person to have tendonitis there at the front of the hip.  It’s even more unusual for a person to have bilateral tendonitis.

And, for the record, it’s extremely scary when that person is a child who’s had Raynauds for four years and has a family history of autoimmune disease.  We all know where this is going, right?  I’m so afraid for my daughter.

Once again, this child was vomiting due to the severity of her hip pain.  400 mg ibuprofen did nothing for her, so after two hours I gave her a second 400 mg dose.  The difference is that this time I didn’t ask if it’s bad enough to make a doctor’s appointment.  I just made the phone call.  And she was highly miffed when I “drug” her to the doctor.

• He noted that she’d been in before with a similar complaint. 
• He did a careful examination and asked lots of questions.
• He offered a steroid injection, but didn’t push knowing that my daughter hates needles.

If it’s me, I’ll let this particular doctor give me a cortisone shot any day.  With my kid, it’s a different story.  It’s tricky finding the right balance of “I’m the mom, you’ll do what I say,” and “You’re an adolescent capable of making some of your own decisions.”

When the doctor also said that he’d be ordering lab work, my daughter looked frightened.  “You mean I either have to get a shot or have my blood drawn?!”  No escape from the needles this time.  I’m so glad to have a good relationship with our family physician.  He told her that she needed the blood work done whether or not she got the shot.

He also said that iliopsoas tendonitis is pretty unusual and he’d like to refer her to an orthopod to figure out what’s going on.  While he did some charting, I had a chance to talk with her.

Still not wanting to push, I let her know, “An orthopedist is going to want to give a steroid injection.  The difference is that our PCP is very good and his shots don’t hurt, plus he uses kenalog which doesn’t make a person sick like depo-medrol does.  If it was me, I’d get the shot now knowing that I’d probably feel better the next day.”  But it was her choice.

I’m happy to report that the injection was very effective and she’s not so afraid of shots now.  Unfortunately, I suspect this was a snowball appointment and we’re about to race downhill accumulating referrals, diagnoses, PT, and medication for my daughter.

This really really sucks.