An Unusual Case Of Lateral Hip Pain - Page #4
 

Working Diagnosis:
Left gluteus medius heterotopic ossification and possible avulsion fracture

Treatment:
Conservative treatment with physical therapy and two autologous blood injections were not helpful.

Surgical exploration demonstrated heterotopic bone formation in the gluteus medius tendon and avulsion of the tendon from the greater trochanter. Heterotopic bone was excised and the gluteus medius tendon was reattached to the bone. Physical therapy and gradual return to activity were prescribed at 3 months post-surgery.

Outcome:
The patient returned to running at 6 months and skiing at 12 months. At 15 months post-surgery he had minimal pain going up and down stairs but was otherwise asymptomatic.

Editor's Comments:
Lateral hip pain is a common complaint in primary care clinics, but accurate diagnosis can be challenging. What is commonly called "trochanteric bursitis" should instead be called "greater trochanteric pain syndrome" which is usually characterized by tendinosis of the gluteus medius or minimus, the main abductors of the hip joint. Bursitis is a rare finding on US or MRI. Other causes of lateral hip pain include hip osteoarthritis, meralgia paresthetica, and lumbar spine conditions.
Hip abductor tendon tears, as in this case, are probably not rare, and should be considered in acute pain or when patients with chronic pain fail to improve with conservative measures.

References:
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2. Grumet RC, Frank RM, Slabaugh MA, Virkus WW, Bush-Joseph CA, Nho SJ. Lateral hip pain in an athletic population: differential diagnosis and treatment options. Sports health 2010;2:191-6.
3. Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2008;24:1407-21.
4. Davies JF, Stiehl JB, Davies JA, Geiger PB. Surgical treatment of hip abductor tendon tears. The Journal of bone and joint surgery American volume 2013;95:1420-5.
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11. Steinert L, Zanetti M, Hodler J, Pfirrmann CW, Dora C, Saupe N. Are radiographic trochanteric surface irregularities associated with abductor tendon abnormalities? Radiology 2010;257:754-63.
12. Cvitanic O, Henzie G, Skezas N, Lyons J, Minter J. MRI diagnosis of tears of the hip abductor tendons (gluteus medius and gluteus minimus). AJR American journal of roentgenology 2004;182:137-43.
13. Davies JF GP, Davies JA, Yahr D,, JM K. Results of open surgical treatment of abductor tendon tears of the hip. American Academy of Orthopaedic Surgeons; 2009; Rosemont, IL. p. 463.
14. McCormick F, Alpaugh K, Nwachukwu BU, Yanke AB, Martin SD. Endoscopic repair of full-thickness abductor tendon tears: surgical technique and outcome at minimum of 1-year follow-up. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2013;29:1941-7.
15. Walsh M WN, Walton J, Millar, N. Surgical repair of the abductor mechanism of the hip. American Academy of Orthopaedic Surgeons; 2009; Rosemont, IL. p. 463.

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