How Is Hip Bursitis Diagnosed

How's Hip Bursitis Diagnosed?

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Hip bursitis at the greater trochanter has historically been identified as the major reason patients experience lateral hip pain. Treatments such as corticosteroid injections or surgery are established based on this general diagnosis. 

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In recent years, growing attention has been directed to hip abductor tendon pathology (HATP) as the cause of lateral hip pain. HATP includes tendinopathies and tendon tears or ruptures of the gluteus medius and minimus tendons. It can be detected using an MRI but unfortunately tends to be under- or misdiagnosed. 

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A study evaluated the presence of isolated trochanteric bursitis on an MRI in patients with lateral hip pain who were referred to a public orthopaedic hip clinic. Patients were referred to MRI by two surgeons if distinct palpable tenderness or pain was detected from gluteus medius and/or gluteus minimus tendon insertions and one or more hip specials tests for lateral hip pain was positive. 

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Results found that 2% of patients were registered with greater trochanteric bursitis with no relevant HATP, 4% of patients had HATP with bursitis in the sub-gluteus minimus bursa with no bursitis in the greater trochanteric bursa, and 25% of patients had elements of inflammation in the greater trochanteric bursa with relevant HATP in the greater trochanteric bursa. The remaining 69% of patients had no high-intensity signals indicating trochanter-related bursitis. Therefore, isolated trochanteric bursitis on MRI was very rare in patients referred to the outpatient orthopaedic clinic for lateral hip pain.   

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These findings are important as they reveal a need to shift focus towards treatment of HATP, especially in patients with lateral hip pain, instead of being treated exclusively for trochanteric hip bursitis. 

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References: 

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Lange J, Tvedesøe C, Lund B, Bohn MB. Low prevalence of trochanteric bursitis in patients with refractory lateral hip pain. Dan Med J. 2022;69(7):A09210714. Published 2022 Jun 15.

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