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Evaluating hip pathology in trochanteric pain syndrome

Evaluating hip pathology in trochanteric pain syndrome

ABSTRACT: Patients may have greater trochanteric pain syndrome for years without knowing a defining cause or seeing pain improvement. Pathology within and around the hip joint falls into one of several categories, including acute pain with trauma, overuse and repetitive motion activities, and diseases and degenerative conditions. Pain is described as deep, occasionally sharp aching and stiffness. A unique set of factors contribute to the stability and function of the joint. The differential diagnosis for hip pathology includes many entities; considering referred pain patterns is important to reduce inappropriate testing. A compartmental approach to testing for hip pathology helps organize causes. Plain radiographs are an important first step in imaging; MRI may help delineate the sources of pain. (J Musculoskel Med. 2008;25:428-436) 

Greater trochanteric pain syndrome (GTPS)—tenderness without inflammation along the side of the hip—often is misdiagnosed because it shares pain patterns with other musculoskeletal conditions. Patients may have the condition for years and may have presented to several clinicians, undergone extensive diagnostic testing, and received several therapies—without seeing a defining cause or improvement of their pain. Undiagnosed hip conditions such as this may result in considerable pain for a frustrated patient who often is labeled a malingerer.

Patient evaluation for GTPS begins with an accurate history and physical examination. Serial diagnostic and therapeutic injections may play an important role in management. Radiological studies, including MR arthrography, often are indicated.

In this 2-part article, we describe the diagnosis and management of hip pathology in GTPS. This first part focuses on patient evaluation and the differential diagnosis. In the second part, to appear in a later issue of this journal, we will discuss approaches to treatment. 

MECHANISM

Pathology within and around the hip joint falls into one of several categories. Acute onset of pain most often is the result of trauma. Acute pain and injury have been observed after a twisting motion. Pathology also may result from overuse and repetitive motion activities. Another category is diseases and degenerative conditions that may result in biomechanical alteration of the structural components of the joint.

CLINICAL PRESENTATION

Pain, a common presentation, is described as deep, occasionally sharp aching and stiffness in the hip. Pain may be localized to the proximal, lateral aspect of the thigh and pelvic rim. Patients often describe the location of pain by cupping their hand over the greater trochanteric region.

 

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