Fascia Lata Injection

Indications and Clinical Considerations

Fascia lata fasciitis syndrome is caused by inflammation of the fascia lata from overuse or misuse. It is characterized by a dull, aching pain in the lateral hip that radiates into the lateral thigh. The pain is frequently worse on rising and improves with initial activity and then again worsens with continued activity, making walking extremely difficult. The patient with fascia lata fasciitis syndrome also may experience pain in the low back at the iliac crest and buttocks on the affected side, caused by muscle spasm. On physical examination, there is diffuse tenderness over the fascia lata laterally, with specific areas of point tenderness along the course of the fascia ( Fig. 168.1 ). Dimpling caused by adhesions of the subcutaneous tissue to the fascia lata is often present. This dimpling can best be identified by placing the patient on his or her side at the edge of the examination table with the affected extremity on top and then having the patient abduct the leg at the hip with resistance ( Fig. 168.2 ). Bursitis of the trochanteric and iliotibial band bursae also may coexist with fascia lata fasciitis syndrome and confuse the clinical picture.

Plain radiographs of the hip and knee may reveal calcification of the trochanteric and iliotibial bursae and associated structures, including the iliotibial band tendon, consistent with chronic inflammation. Magnetic resonance imaging is indicated if internal derangement, occult mass, or tumor of the hip or knee is suggested. Electromyography helps distinguish fascia lata fasciitis syndrome from diabetic neuropathy, meralgia paresthetica, lumbar radiculopathy, and plexopathy. The injection technique described later serves as both a diagnostic and a therapeutic maneuver.