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Figure. Anteroposterior radiograph of the left hip.
A 60-year-old woman presents with a 6-month history of left lateral hip pain. She has tried physical therapy and has undergone 2 greater trochanteric bursa injections with minimal relief. Anteroposterior radiograph of the left hip (Figure) is obtained. When the patient performs a single leg stance on the affected leg, the opposite hip drops.
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Lateral hip pain is a common presenting complaint in orthopedic practice. The most common causes of lateral hip pain include greater trochanteric bursitis, gluteus medius tendinitis or tearing, and snapping hip syndrome, with the most common cause of lateral hip pain being trochanteric bursitis.1 The greater trochanteric bursa is a fluid-filled sac between the bony prominence of the greater trochanter and the iliotibial band. The bursa helps reduce friction as the hip moves in flexion and extension. Greater trochanteric bursitis is thought to be caused by trauma to the hip, repetitive hip flexion, or abnormal gait pattern. Side bending, lying on the affected side, and prolonged sitting may aggravate symptoms.
In the short term, corticosteroid injection is an effective treatment option for treating trochanteric bursitis. However, treatment with physical therapy is essential for preventing recurrent symptoms. Leg length discrepancies can cause increased tension on the iliotibial band over the trochanteric bursa, which may be why trochanteric bursitis often occurs in patients following total hip arthroplasty, a procedure that may lengthen the involved extremity. A patient with suspected trochanteric bursitis that fails to improve over 4 to 6 months with corticosteroid injections and physical therapy should undergo magnetic resonance imaging to rule out gluteus medius pathology. The gluteus medius can be tested by having the patient perform a single leg stance on the affected leg. A drop in the pelvis of the unsupported side (positive Trendelenburg test) is a sign of abduction weakness and potential gluteus medius pathology.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
References
1. Redmond JM, Chen AW, Domb BG. Greater trochanteric pain syndrome. J Am Acad Orthop Surg. 2016;24(4):231-240.
2. Mascarenhas R, Frank RM, Lee S, Salata MJ, Bush-Joseph C, Nho SJ. Endoscopic treatment of greater trochanteric pain syndrome of the hip. JBJS Rev. 2014;2(12):e2.
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