Background Greater trochanteric pain syndrome consists of a common clinical syndrome including ?classical? trochanteric bursitis but also gluteus medius pathology, with main clinical features being pain and tenderness over the lateral aspect of hip.
Objectives To assess the prevalence of trochanteric bursitis and gluteus medius tendonitis by ultrasound examination, together or in isolation, in patients with greater trochanteric pain syndrome and to investigate whether different clinical features could be related to ultrasound findings.
Methods 36 (34F/2M) patients with greater trochanteric pain syndrome were studied retrospectively. A coxofemoral or lumbar origin of pain was ruled out in all these patients. The following variables were used: age, disease duration, presence of obesity or leg length inequity, pain type (use-related/at rest) and location (trochanter, buttock or both), Trendelemburg sign and ressted hip abduction or internal rotation, and also the existence of calcifications or significant osteoarthritis changes on X-ray examination.
Results Acute or chronic signs of gluteus medius tendinitis were found in 22 patients (61%), and inflammatory changes suggesting both trochanteric bursitis and gluteus medius pathology were detected in 12 (33%); isolated trochanteric bursitis was found in only 2 cases (6%). Disease duration was longer in patients with inflammatory changes at both locations (14 mo vs 6 mo, p = 0.018), but there were no differences relating age. No significant clinical features allowed differentiation of the ultrasound findings, although a tendency towards pain location defining the underlying pathology could be observed (p = 0.062 for trochanteric pain, p = 0.09 for buttock pain). Patients showing inflammatory changes in both gluteus and trochanteric bursa on ultrasound tended to be more obese than those without bursitis (p = 0.073) and calcications on X-ray tended to be found more frequently in those with only gluteus medius tendonitis (p = 0.082).
Conclusion Isolated trochanteric bursitis was rarely found on ultrasound examination in patients with greater trochanteric pain syndrome, but gluteus medius tendon inflammatory changes could be found in the vast majority of cases, most of them without associated trochanteric bursitis. No reliable clinical features could be used to distinguish between ultrasound changes.