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Differential Diagnosis of Lateral Hip Pain: Clinical Tests Compared to MRI Results

Posted on: 11/30/1999
Patients who report "hip pain" often point to the side of the hip over the region of the greater trochanter. The greater trochanter can be felt along the side of your hip. It is a large bump that juts outward from the top of the femur.

Large and important muscles connect to the greater trochanter. One muscle is the gluteus medius. It is a key muscle for keeping the pelvis level during standing and walking.

Pain over the greater trochanter is called lateral hip pain. But true hip joint pain really occurs in the front of the body close to the groin area or deep in the buttocks. Pain in the area of the greater trochanter is more likely from problems with the gluteal (buttock) muscles.

In this study, patients with lateral hip pain were examined by physical therapists (PTs). MRIs were also taken. The results of these two test measures were analyzed and compared. The study had three areas of focus: 1) Use MRIs to find out which soft tissue structures may be the cause of lateral hip pain. 2) See which structures PTs think are causing the problem. And 3) Look for valid tests to predict gluteal tendon pathology.

On the basis of clinical tests performed, the PTs listed the muscles they thought were involved. They also said whether the problem was muscle weakness, tendon tear, or tendinosis (tendon degeneration).

The PT's diagnosis was compared to the MRI diagnosis. Using this method of comparing, the researchers were able to test the accuracy of the clinical tests. Overall, there was little agreement between the radiologic and PT diagnoses. The reason for this lies with the MRIs.

MRIs did not show a difference between tendinosis and a partial tear. Just as many patients without symptoms had significant MRI findings of tendon problems. Abnormal bursae were seen in patients with and without lateral hip pain.

The authors point out that the results of clinical tests for lateral hip pain can't be compared to MRIs yet. There is a need to further refine the imaging before MRIs can be used as a standard for diagnosis.

PTs were able to identify bursitis but not tendon problems. Further research is needed to develop accurate clinical tests to assess gluteal tendinopathy.

Stephanie J. Woodley, BPhty, MSc, PhD, et al. Lateral Hip Pain: Findings From Magnetic Resonance Imaging and Clinical Examination. In Journal of Orthopaedic & Sports Physical Therapy. June 2008. Vol. 38. No. 6. Pp. 313-328.

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