Greater trochanteric pain syndrome: a simplified MRI approach

Abstract

Background Greater trochanteric pain syndrome (GTPS) refers to pain and tenderness over the greater trochanter. It is a common entity of lateral hip pain that is usually related to the overuse or small injuries of the gluteus medius or minimus tendons and their surrounding bursae. MRI is the favored modality for evaluation of the hip region disorders. Treatment options ranges from conservative to surgical treatment. Results Trochanteric (sub-gluteal maximus) bursal fluid was the most common finding found in 55 hips (73%), followed by gluteal tendinosis (64%) and partial thickness gluteal tendon tear (29%). Full thickness tear of the gluteal tendons occurred in 10 hips (13%). The relation between gluteal tendinosis and greater trochanteric bursal fluid was statistically significant (P < 0.05) with sensitivity and specificity of 85% and 78% respectively. Conclusion MRI should be utilized in a simple systemized approach by MSK radiologist in order not to miss a finding that may influence the surgical outcome of the patient presenting with GTPS.

Management of Hip Abductor Tears and Recalcitrant Trochanteric Bursitis in Native Hips

“…In cases of chronic lateral hip pain, an MRI can rule out other soft-tissue pathologies around the hip and is the preferred imaging choice when attempting to diagnose lateral hip pain. 18 However, trying to determine when to order advanced imaging, and in whom, remains a challenge. [18][19][20] While we tend to discourage the comparisons, indicating who should have an MRI ordered should likely follow rotator cuff recommendations.…”

“…18 However, trying to determine when to order advanced imaging, and in whom, remains a challenge. [18][19][20] While we tend to discourage the comparisons, indicating who should have an MRI ordered should likely follow rotator cuff recommendations. In general, patients with persistent, recalcitrant lateral hip pain, in the absence of acute trauma, should be considered for an MRI after a period of nonsurgical management.…”

“…In general, patients with persistent, recalcitrant lateral hip pain, in the absence of acute trauma, should be considered for an MRI after a period of nonsurgical management. [18][19][20] Patients with an acute, traumatic onset of lateral hip pain with associated severe ambulatory and/or strength dysfunction should obtain an MRI acutely before nonsurgical management. 21 A description of common MRI findings can be helpful to the practitioner in differentiating lateral hip pathology.…”

“…Increased tendon thickness and interstitial edema with preserved continuity of the tendon are seen with gluteal tendinosis (Figure 1). 18 Partial loss of tendon continuity is seen with partial-thickness tear of the gluteal medius or minimus tendon (Figure 2). 18 Full-thickness tear of the gluteal tendons will present with findings of retracted tendon ends with or without a fluid gap (Figure 3).…”

“…18 Partial loss of tendon continuity is seen with partial-thickness tear of the gluteal medius or minimus tendon (Figure 2). 18 Full-thickness tear of the gluteal tendons will present with findings of retracted tendon ends with or without a fluid gap (Figure 3). 18 Finally, bursal fluid lying superficial to the gluteal medius tendon or deep to either the gluteal medius or minimus tendon can help differentiate between simple trochanteric bursitis (superficial) (Figure 4) and tendinosis versus partial tear (deep).…”