Hip iSAWE 8

Question

A 55 year old woman has lateral hip pain, worse lying on that side and climbing stairs. She is tender over the greater trochanter.

Hip iSAWE 8, coronal stir mri of the hip
Coronal STIR MRI of the hip. Image by Mohamed Jarraya, Daichi Hayashi, Frank W. Roemer, Michel D. Crema, Luis Diaz, Jane Conlin, Monica D. Marra, Nabil Jomaah and Ali Guermazi, Wikimedia Commons, CC BY 3.0.
  1. What is the diagnosis and pathology?
  2. How would you investigate her?
  3. What are the treatment options?

Answer

Diagnosis and pathology

  • Greater trochanteric pain syndrome (gluteal tendinopathy)
  • Tendinopathy or tears of gluteus medius and minimus, with secondary trochanteric bursitis
  • Common in women aged 40 to 60, linked to obesity and a wide pelvis
  • Positive single leg stance for 30 seconds and resisted external derotation test

Investigations

  • Exclude hip arthritis and lumbar referred pain
  • Radiographs of the pelvis and hip
  • Ultrasound or MRI for tendinopathy and full thickness tears

Treatment

  • Load management and education, avoiding sitting cross legged and lying on the affected side
  • Education with exercise gave better outcomes than corticosteroid injection at 8 weeks (LEAP trial, BMJ 2018)
  • Corticosteroid injection gives short term relief
  • Platelet rich plasma has mixed evidence
  • Surgical repair of full thickness gluteal tears with abductor weakness
  • Iliotibial band release and bursectomy for refractory cases

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.