Diagnosis of greater trochanteric pain syndrome

Differentiation of the various causes of greater trochanteric pain syndrome is usually possible on careful clinical examination of the hip. People with greater trochanteric pain syndrome most commonly have tenderness at the posterolateral border of the greater trochanter over the gluteal tendons. In cases of true greater trochanteric bursitis, tenderness is felt over the lateral aspect of the greater trochanter. If tenderness in the greater trochanteric region is absent, greater trochanteric pain syndrome is very unlikely and alternative diagnoses should be considered.

In people with gluteal tendinopathy, specific clinical tests that induce pain may be positive. These tests include:

• one-legged stance—the person stands on the affected leg for 60 seconds or less; if this provokes pain it is likely associated with gluteal tendinopathy
• resisted hip internal rotation
• resisted external derotation test—with the person lying supine, flex the hip and knee to 90 degrees, place the hip into full external rotation, then ask them to return the hip to neutral against resistance; see an instructional video.

Gluteal tendon tears may be a cause of weak hip abduction. The Trendelenberg sign identifies weakness of hip abduction. In a positive test, when standing on the affected leg for 30 seconds, the pelvis drops to the contralateral side; see an instructional video.

Greater trochanteric pain syndrome is a clinical diagnosis and may not require any investigation. When the diagnosis is not clear clinically, investigation is appropriate and ultrasound scan is the best option. Bursal fluid, peritrochanteric oedema and gluteal tendinopathy may be seen; however, these are frequent findings in asymptomatic people. Perform a magnetic resonance imaging (MRI) scan with caution; any findings should be carefully correlated with clinical features as abnormalities are common in asymptomatic people.