Greater trochanteric pain syndrome — SCE Rheumatology MCQ

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EasyOsteoarthritis and soft tissue rheumatologyGreater trochanteric pain syndromeSCE Rheumatology

A 62-year-old woman reports lateral hip pain that is worse when lying on the affected side. Examination shows focal tenderness over the greater trochanter, and resisted hip abduction reproduces her lateral hip pain. Passive hip internal rotation is full and painless. What is the most likely diagnosis?

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Correct answer: E — Greater trochanteric pain syndrome

The diagnosis is greater trochanteric pain syndrome. The discriminating features are lateral hip pain worsened by side-lying, focal tenderness over the greater trochanter and reproduction of pain with resisted abduction, reflecting gluteal tendon or adjacent peritrochanteric pathology. Full, painless passive internal rotation argues against symptomatic hip osteoarthritis, which more typically causes groin pain and restricted or painful hip movement. Septic arthritis usually produces severe pain with passive movement, often with systemic illness. Lumbar radiculopathy would be supported by radiating neuropathic pain, neurological abnormalities or nerve-root tension signs rather than focal trochanteric tenderness. Polymyalgia rheumatica causes bilateral shoulder and hip-girdle aching with prolonged morning stiffness, not isolated focal lateral hip pain.

Reference: Kinsella R, et al. Diagnostic Accuracy of Clinical Tests for Assessing Greater Trochanteric Pain Syndrome: A Systematic Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2024;54(1):26-49. https://pubmed.ncbi.nlm.nih.gov/37561820/