Lateral Pain

Lateral hip pain (see Table 3) is usually associated with greater trochanteric pain syndrome, iliotibial band syndrome, or meralgia paresthetica. Greater Trochanteric Pain Syndrome is a relatively new term that includes greater trochanteric bursitis and gluteus medius pathology (Shbeeb 1996, Bird et al 2001). Trochanteric bursitis is a common cause of lateral hip pain, especially in older patients. However, a magnetic resonance imaging (MRI) study of 24 women with greater trochanteric pain syndrome (described as chronic pain and tenderness over the lateral aspect of the hip) found that 45.8% had a gluteus medius tear and 62.5% had gluteus medius tendonitis, calling into question how many of these patients actually have bursitis (LOE=4) (Bird et al 2001). Iliotibial band syndrome is particularly common in athletes. It is caused by repetitive movement of the iliotibial band over the greater trochanter. Meralgia paresthetica, an entrapment syndrome of the lateral femoral cutaneous nerve, is another cause of lateral hip pain that occurs more frequently in middle age. Meralgia paresthetica is characterized by hyperesthesia in the anterolateral thigh, although 23% of patients with this disorder also complain of lateral hip pain (Jones 1996).

Table 3: Lateral Pain Presentation and Findings (Margo et al (2003)
  Disorder Presentation and exam findings
Lateral pain Greater trochanteric bursitis Female:male 4:1, fourth to sixth decade
Spontaneous, insidious onset lateral hip pain
Point tenderness over greater trochanter
Gluteus medius muscle dysfunction Pain with resisted hip abduction
Tender over gluteus medius (cephalad to greater trochanter)
Trendelenburg test: sensitivity 72.7%, specificity 76.9% for detecting gluteus medius muscle tear (LOE=2b)
Iliotibial band syndrome Lateral hip pain or snapping associated with walking, jogging, or cycling
Positive Ober's test
Meralgiaparesthetica Numbness, tingling, and burning pain over anterolateral thigh
Aggravated by extension of hip and with walking
Pressure over nerve may reproduce dysesthesia in distribution of lateral femoral cutaneous nerve (LOE=5) (Grossman et al 2001)



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