Review Question - QID 216653

This patient who presents with lateral hip pain that is most prominent while climbing stairs and is severely tender to palpation with no other deficits on physical exam most likely has greater trochanteric pain syndrome. One cause of this syndrome is gluteus medius tendinitis.

The greater trochanter is a lateral structure on the proximal femoral metaphysis that serves as the insertion site for the abductors and external rotators of the hip. Though the anatomy varies slightly from person to person, up to 6 different bursa can surround the musculotendinous structures that travel close to the greater trochanter. Inflammation of these structures can result in superficial lateral hip pain that is exacerbated by the use of these muscles or compression of the inflamed area. The most common causes include iliotibial band snapping and gluteus medius/minimus tendinopathy. Notably, this pain can be reproduced by superficial palpation but will not occur with deep neurovascular or joint physical exam maneuvers.

Incorrect Answers:
Answer 2: Iliopsoas tendinitis would cause bursitis and pain over the lesser trochanter. This structure is posteromedial, so the pain would present on the inside of the thigh rather than the lateral surface.

Answer 3: Osteoarthritis can also present with hip pain; however, this pain is usually deep and is not reproduced with superficial palpation. Resisted hip flexion (Stinchfield test) usually reproduces the sensation of deep groin pain in this condition.

Answer 4: Rheumatoid arthritis can also present with hip pain; however, patients with this disease usually have dramatically decreased range of motion and deep rather than superficial pain. Internal rotation of the hip is usually the first direction that is limited in this disease.

Answer 5: Sciatic nerve compression can also cause lower extremity pain, but this pain classically radiates down past the knee. Straight leg raise is a very sensitive test for reproducing this pain.

Bullet Summary:
Greater trochanteric pain syndrome is most commonly caused by an iliotibial band or gluteus medius/minimus dysfunction.