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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