MRI and trochanteric bursitis
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Lateral hip pain is usually due to greater trochanteric pain syndrome, iliotibial band syndrome, or meralgia paresthetica.
Greater trochanteric pain syndrome is a relatively new term that includes greater trochanteric bursitis and gluteus medius tendonopathy. Trochanteric bursitis is a common cause of lateral hip pain, especially in older patients.
However, a magnetic resonance imaging (MRI) study of 24 women with greater trochanteric pain syndrome (described as chronic pain and tenderness over the lateral aspect of the hip) found that 45.8% had a gluteus medius tear and 62.5% had gluteus medius tendonitis, calling into question how many of these patients actually have bursitis ( Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum 2001; 44:2138–2145)
Another study evaluated 16 patients and also demonstrated the utility of magnetic resonance imaging in evaluating trochanteric hip bursitis. (Lee, KJ, et al. MR features of bursitis around the hip. J Korean Radiol Soc. 1998 Dec;39(6):1221-1226. Korean.)
The distinction between trochanteric bursitis and gluteus medius tendonopathy is important because the former usually responds to ultrasound guided glucocorticoid injection while the latter responds well to ultrasound guided percutaneous needle tenotomy with platelet-rich plasma.
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