Lateral hip pain – more likely gluteus medius tendinopathy than ‘trochanteric bursitis’

Our New Zealand colleagues had a great sports medicine conference in Wellington this week following their successful hosting of the World Championships in Rowing. Congratulations to Dr Chris Milne and colleagues from all disciplines who made this a success.

In a conversation with Chris I was reminded that the lateral hip pain label of  ‘trochanteric bursitis’ is often given to what is really gluteus medius tendinopathy. As with other tendon problems, the hip external rotator tendons can fail (tendinosis), causing lateral hip pain, pain with getting out of the car to that side and eventually even aching in upper thigh.

MR technology highlighted this pathology as ‘rotator cuff tear of the hip’ in the late 1990s. I always wondered why hip external rotator strengthening was effective for a condition that was meant to be a ‘bursitis’. In a nice BMJ study, cortisone injection to the ‘bursa’, even under fluroscopic control, was not effective – further suppport that the diagnosis is not ‘trochaneric bursitis’. Today’s tip – if you are thinking ‘trochanteric bursitis’, put ‘ gluteus medius tendinopathy’ down as the diagnosis and most times you’ll be glad you did.

Remember too that this is an important differential in the older person – hip OA radiates to the GROIN and patients generally DON’T point to the lateral hip region with their finger when they have OA.

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