A 53-year-old man comes to the office due to right-sided lateral hip pain that makes it difficult for him to lie on that side while sleeping. He describes the pain as burning and localizes it to the outer surface of his thigh. Because the patient has not been able to sleep well due to the pain, he now feels fatigued. The pain has recently occurred during the day and is worse with activity and prolonged standing. The patient has no other medical conditions and takes no medications. Vital signs are within normal limits. BMI is 37 kg/m². Physical examination shows tenderness over the lateral aspect of the right hip and buttock with deep palpation. Neurologic examination shows no abnormalities. Which of the following is the most likely cause of this patient's pain?

Question

Quizplus · Accepted Answer

11ec25c8_d86a_d667_bc81_95f99a1c3c23_MD0003_00 This patient has greater trochanteric pain syndrome (GTPS). GTPS is an overuse syndrome involving the tendons of the gluteus medius and minimus where they run over the greater trochanter. GTPS is sometimes termed "trochanteric bursitis," although the bursae are not the source of pain in most patients. GTPS typically presents with chronic lateral hip pain that is worsened with repetitive hip flexion (eg, climbing stairs, walking uphill, getting out of a car) or lying on the affected side. gluteus medius and minimus lateral hip pain This diagnosis of GTPS is based primarily on clinical findings. Physical examination shows local tenderness over the greater trochanter during flexion. Hip range of motion is normal, although abduction may aggravate the pain. X-ray is commonly performed to rule out concurrent hip joint disorders; ultrasound may show chronic degeneration/tendinosis in the affected tendons. Initial treatment of GTPS includes local heat, activity modification, and nonsteroidal anti-inflammatory drugs (NSAIDs). Physical therapy is often helpful as well. Patients with persistent symptoms despite conservative therapy may benefit from local corticosteroid injection. (Choice A) Stress fracture of the femoral neck can cause lateral hip pain. However, this condition is typically caused by prolonged, strenuous exercise (eg, a runner training for a marathon) and is otherwise uncommon in patients without underlying bone disease. (Choice C) Hip osteoarthritis usually causes pain in the deep, medial aspect of the joint. Radiation to the groin or thigh is more typical than radiation to the lateral hip, and this patient's tenderness over the trochanter is more consistent with GTPS. (Choice D) Iliotibial band syndrome is a common overuse syndrome that arises where the iliotibial band passes over the lateral femoral condyle. It presents with lateral knee, not hip, pain and tenderness at the condyle, just proximal to the knee joint. (Choice E) Meralgia paresthetica is caused by compression of the lateral femoral cutaneous nerve where it passes under the inguinal ligament. The pain and paresthesia typically occur in a variable region of the midlateral thigh. Trochanteric tenderness would not be seen. (Choice F) Osteoid osteoma is a benign tumor that commonly affects the proximal femur, and can cause nocturnal pain. However, it typically occurs in children, adolescents, and young adults and is rare in older individuals. Also, although children have focal tenderness, adolescents and older patients often have no focal examination abnormalities. Educational objective: Greater trochanteric pain syndrome is an overuse syndrome involving the tendons of the gluteus medius and minimus at the greater trochanter. It presents with chronic lateral hip pain that is worsened with repetitive hip flexion or lying on the affected side. Physical examination shows local tenderness over the greater trochanter.

A 53-Year-Old Man Comes to the Office Due to Right-Sided