Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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J.C. Campbell and G.D. Paiement
cuff tear of the hip,” some authors of small series advocate arthroscopic
debridement and repair for large tears [ 22 ], although limited evidence
currently exists to advocate for or against these procedures. Additionally,
its role in greater trochanteric bursitis is becoming clearer, as some
believe the presence of tendonitis of either the gluteus medius or minimus
is the primary pathology in greater trochanteric bursitis [ 23 ].
Physical Exam Patients with gluteus medius tendonitis present with
pain in the hip or groin, exacerbated with activity. Patients have focal
tenderness to palpation and pain with resisted abduction. In severe
tendonitis or in cases in which a gluteus medius tear is present, patients
may demonstrate weakness of the abductors and a positive Trendelenburg
gait. Testing will reveal they are unable to keep their hips level during
single-leg stance of the affected side.
Diagnostic Exams X-ray is unrevealing, and the diagnosis is clinical.
MRI has a role if there is concern for a gluteus medius tear. MRI should
be considered in cases of tendonitis nonresponsive to multimodality
treatment, such as physical therapy and steroid injections.
Differential Greater trochanteric bursitis is almost identical in
presentation, and as understanding of the process grows, it is increasingly
becoming inseparable from gluteus medius tendonitis.
Appropriate Treatment/Referral The first line of treatment is a
dedicated course of NSAID therapy combined with physical therapy.
Referral to an orthopedic surgeon for steroid injections is warranted if
the patient does not respond to 4–6 weeks of physical therapy. If patients
fail to improve, it is reasonable to consider an MRI to evaluate for a tear
or other causes for the patient’s pain.
Greater Trochanteric and Iliopsoas Bursitis
Presentation With greater trochanteric bursitis , patients will typically
present with lateral hip and leg pain radiating down the side of the leg
and into the knee, along the iliotibial (IT) band. Patients have difficulty
sleeping on the affected side. They have increased pain with flexion of
the hip, as this tightens the IT band against the greater trochanter.