A 66-year-old woman comes to the physician because of progressively worsening hip pain over the last several weeks. The pain is localized to the lateral aspect of her left hip over the outer thigh, but sometimes extends to her left buttock and knee. Her pain increases when she climbs stairs, gets out of the car, and stands up from sitting in a deep chair. She also notes that the pain sometimes occurs with walking or prolonged standing. On occasion, the pain awakens her from sleep when she rolls onto her left side.
She denies fever, chills, or constitutional symptoms. She cannot recall any trauma to the area and has had no falls. Her medical problems include obesity (BMI 30 kg/m²) , type 2 diabetes mellitus, hypertension, hyperlipidemia, chronic low back pain, and depression.
Which of the following is the most likely cause of this patient's current complaints?

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11ec193a_9920_e480_853d_4b6e2b8cd1a6_MD0002_00 This patient's presentation is consistent with trochanteric bursitis, which is caused by exaggerated movement of the gluteus medius tendon and tensor fascia over the outer femur. Patients usually present with lateral hip pain over the outer thigh that is worsened with repetitive hip flexion (eg, climbing stairs & getting out of a car) or lying on the affected side. Trochanteric bursitis pain occasionally radiates into the ipsilateral buttock and knee. 11ec193a_9920_e481_853d_73e0d32bf46e_MD0002_00 Physical examination usually reveals local tenderness over the midpoint of the greater trochanter during flexion. Hip range of motion is normal. Some patients may have mild gait disturbance due to pain. Diagnosis is suspected clinically, but can be confirmed if the hip pain improves with regional anesthetic block. Hip x-rays may show nonspecific calcification in the bursa. Treatment initially includes local heat, conservative measures (eg, reduction of weight bearing, repetitious bending & direct pressure on the bursa), and NSAIDs. Patients with persistent symptoms despite conservative therapy require further evaluation (eg, CT or MRI of the back) and corticosteroid bursal injection. (Choice A) Intermittent claudication from occlusive aortoiliac disease can cause pain in the buttock, hip, or thigh. However, the pain tends to be aching and progressively worsens with activity. In addition, claudication is usually not associated with lateral hip pain. (Choice B) Lumbar spinal stenosis can produce back pain that radiates into the buttock and thigh, but the symptoms are usually bilateral. (Choice C) Meralgia paresthetica is due to lateral femoral cutaneous sensory nerve entrapment, and usually presents with decreased sensation to pinprick and light touch over the antero-lateral upper thigh. The location of this patient's pain makes this diagnosis less likely. (Choice D) Osteoarthritis of the hip is usually associated with groin pain rather than lateral hip pain during flexion. Also, osteoarthritis of the hip would be associated with limited range of motion and discomfort with abduction. Educational objective: Trochanteric bursitis usually presents with lateral hip pain that can radiate into the buttock or toward the knee. Examination typically reveals point tenderness over the midpoint of the greater trochanter. Treatment involves local heat, muscle strengthening exercises, conservative measures, and NSAIDs. Persistent symptoms require further evaluation and corticosteroid injection. __________ References: Trochanteric bursitis: a common clinical problem. (http://www.ncbi.nlm.nih.gov/pubmed/3778178) Efficacy of treatment of trochanteric bursitis: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/21814140)

A 66-Year-Old Woman Comes to the Physician Because of Progressively