Consent✅ - this is a beauty 🤓 Elite runner Crampy, aching lateral knee pain - onset at around 20-30 mins Seen multiple clinicians - had numerous injections including ITB plus extensive rehabilitation - refractory Almost 'claudicant' in nature - settles quickly on cessation of exercise - spreads both proximal & distal to lateral joint line No spinal symptoms & LSp assessment clear No lateral compartment pathology eg meniscal tear Had popliteus tendinopathy on US, but minimal response to my initial diagnostic injection POCUS video - The inferolateral genicular neurovascular bundle ('pepper pot' structure) is seen compressed under the distal ITB on active knee flexion : terminal extension Patient localises pain in this area with probe pressure Injection - hydrodissection (CSI, LA) - fluid seen separating plane just superficial to NV bundle 100% pain relief on extended treadmill test beyond 45 mins 👍 I wonder how many recalcitrant 'ITB' cases are actually neurovascular in aetiology? 🧐 Plan - considering angiography, MR neurography & possible distal ITB release at Gerdy's tubercle if not responsive to injection

For the people at the back - 1. Distance runner with ramp in load +/- REDS risk factors 2. Positive hop test 3. Positive FADDIR 4. Weak / painful on iliopsoas testing This is 99.9% likely to be a neck of femur stress injury IT ISN'T A TIGHT HIP FLEXOR