Case 18

Discussion:

Lateral hip pain can be a clinically challenging diagnostic problem. Trochanteric bursitis is defined by painful inflammation of the greater trochanter bursa. This may occur in physically active patients or in sedentary individuals. Most often caused by overuse, stress or direct trauma to the joint. Usually unilateral but can be bilateral.

Recently, an expanded spectrum of pathologic abnormalities affecting the soft tissues of the hip has been noted, with such findings including not only trochanteric bursitis but also the so-called rotator cuff tears of the hip. MRI studies for greater trochanteric pain syndrome found tear involving gluteus medius tear and gluteus medius tendonitis, calling into question how many of these patients actually have bursitis. In fact, the coexistence of trochanteric bursitis and abductor tendinopathy has led some authors to suggest that bursitis may in fact be a result of the underlying tendinopathy.

Differential considerations of lateral hip pain includes: AVN, hip arthritis; insufficiency fractures, pseudotrochanteric bursitis, adiposis dolorosa, tensor fasciae femoris syndrome, abductor muscle strain, and a spinal source of pain.

References:

• Kingzett -Taylor A, Tirman PF, Feller J, McGann W, Prieto V, Wischer T, Cameron JA, Cvitanic O, Genant HK. Tendinosis and tears of the gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings. AJR 1999;173:1123-1126.
• Bunker TD, Esler CN, Leach WJ. Rotator-cuff tear of the hip. J Bone Joint Surg Br 1997; 79:618-620.
• Kagan A, II. Rotator cuff tears of the hip. Clin Orthop 1999; 368:135-140.
• Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum 2001; 44:2138–2145