200 Section - Beyond Gluteal Tendinopathy: Ilioinguinal Neuropathy

Tuesday, May 19, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

EP

Esther Pages, MD

Clinical Coordinator- Rehabilitation Department
Hospital Nostra Sra de Meritxell
Escaldes-Engordany, Escaldes-Engordany, Andorra

Co-Author(s)

CG

Christian Grillo-Garcia, MD

Staff member - Rehabilitation Departmetn
Hospital Nostra Sra de Meritxell
Esclades-Engordany, Escaldes-Engordany, Andorra
AB

Anna Boada-Pladellorens, MD

Staff member Rehabilitation Department
Hospital Nostra Sra de Meritxell
Escaldes-Engordany, Escaldes-Engordany, Andorra
Merce Avellanet, MD (she/her/hers)

Head of Department
Hospital Nstra sra de Meritxell
Escaldes-Engordany, Escaldes-Engordany, Andorra

Case Diagnosis: Ilioinguinal nerve neuropathy presenting as chronic lateral hip pain mimicking greater trochanteric pain syndrome (GTPS) in a young adult woman with a history of hip arthroscopy.

Case Description: A 32-year-old woman with a prior left hip arthroscopy for femoroacetabular impingement (CAM-type) and labral repair presented with left hip pain refractory to treatment. Pain involved the lateral hip, with occasional inguinal radiation, worseninig with sitting and stair climbing. She was initially diagnosed with gluteus medius tendinopathy within the GTPS spectrum. The patient failed treatment with nonsteroidal anti-inflammatory drugs, pregabalin, physiotherapy, ultrasound-guided trochanteric injections (platelet-rich plasma and corticosteroids), and extracorporeal shockwave therapy. The presence of inguinal pain prompted reconsideration of the diagnosis. Pelvic MRI showed an internal oblique muscle lesion near the iliac crest, affecting the anatomical pathway of the ilioinguinal and iliohypogastric nerves, without clear signs of nerve compression. Electromyography was normal. An ultrasound-guided diagnostic ilioinguinal nerve block with bupivacaine resulted in significant pain relief, confirming the diagnosis.

Discussions: Lateral hip pain is most frequently attributed to GTPS; however, neuropathic causes should be considered, particularly in patients with prior hip or pelvic surgery and atypical pain distribution. Ilioinguinal nerve neuropathy, although uncommon, may present with overlapping lateral hip and inguinal symptoms, leading to diagnostic delay. Imaging and electrophysiological studies may be inconclusive, highlighting the value of ultrasound-guided nerve blocks as diagnostic and therapeutic tools. This case emphasizes the importance of reassessing the differential diagnosis when conventional treatments fail.

Conclusions: Not all lateral hip pain is attributable to gluteal tendinopathy. Postoperative neuropathies, including ilioinguinal nerve involvement, should be included in refractory cases. Ultrasound-guided nerve blocks represent an effective, minimally invasive strategy for diagnosis and symptom management, helping to avoid prolonged ineffective treatments—and reminding clinicians that sometimes the problem lies just beyond the gluteus medius.