Lateral Hip Pain ...what could it be?
Lateral hip pain right over the greater trochanter region is a common complaint. It could be hip OA, but if it is a patient in their 20’s or 30’s, OA is highly unlikely especially if there is no groin pain or loss of hip medial rotation ROM.
If the lateral hip pain is severe or unresponsive to PT, an x-ray may be warranted to rule out a stress fracture at the femoral neck.
Once OA & fractures have been ruled out, the most likely diagnoses are greater trochanteric bursitis (GTB) and gluteal tendinopathy (GT) usually due to running & cycling or after a direct trauma to the lateral hip.
The hallmark sign of both GTB and GT is local tenderness over the greater trochater area and pain aggravated by walking & stairs.
This 2017 study looked at 65 patients with lateral hip pain and their MRIs were read by a blinded radiologist. A positive MRI for GT was considered if the radiologist reported an increase in intratendinous signal intensity at the gluteal insertion into the greater trochanter.
Reproduction of the lateral hip pain within 30 seconds of single leg standing was strongly associated with GT on MRI (specificity 100%).
A 2008 study showed that the resisted external derotation test in supine also had good sensitivity and specificity for diagnosing GTB & GT.
Gluteal weakness is another hallmark sign of GT as a 2016 study demonstrated that those with unilateral GT had significant weakness into hip abduction in bilateral hips when compared with healthy controls. What we cannot conclude from
References: 1) Allison et al Hip Abductor Muscle Weakness in Individuals with Gluteal Tendinopathy. Med Sci Sports Exerc. 2016 Mar;48(3):346-52.
2) Grimaldi A et al Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain.
3) Lequesne et al Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. Arthritis Rheum. 2008 Feb 15;59(2):241-6.Br J Sports Med. 2017 Mar;51(6):519-524.