A 54-year-old female presents with a nine-month history of gradually worsening pain over the outer aspect of her right hip.
She describes a deep ache that’s aggravated by walking, climbing stairs, and lying on her side at night. There is no history of trauma.
The patient was previously diagnosed with ‘hip bursitis’ and prescribed NSAIDs, which gave only temporary relief.
On examination:
- Tenderness over the greater trochanter
- Pain reproduced with resisted hip abduction and external rotation
- Single leg stance causes discomfort after 30 seconds
- No groin pain or significant restriction in hip internal rotation
- Lumbar spine is non-tender with full range of motion
A pelvic X-ray was unremarkable.
#1. What is the most likely diagnosis?
Results
Correct!
Answer: C – Gluteal tendinopathy (gluteus medius/minimus)
This is a classic presentation of gluteal tendinopathy, the most common cause of lateral hip pain, especially in women over 40.
Key clinical clues include pain with single leg stance, reproduction with resisted abduction and external rotation, no groin pain, and minimal benefit from NSAIDs. Imaging is often unremarkable.
Trochanteric bursitis (D) is often coexistent but secondary. True hip OA (A) usually causes groin pain and joint stiffness.
ITB syndrome (B) is more common in runners and affects the lateral thigh/knee. Lumbar radiculopathy (E) would present with dermatomal pain, paresthesia, or neurological signs.
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