A New Perspective on Lateral Hip Pain

A New Perspective on Lateral Hip Pain Blog

Persevering lateral hip pain is a known complaint by females over fifty, with 23.5% reporting either unilateral or bilateral hip pain. Lateral hip pain occurs in women four times more often than in men. Trochanter bursa is a fluid filled sac circumfering a trochanter joint. When it inflames, it is taken as the underlying source of pain, and treatment usually centers on anti-inflammatory medication. However, recent research does not support Trochanteric Bursitis as the primary cause of lateral hip pain.

Potential Causes of Lateral Hip Pain

The hip is a complex joint, located in the midst of numerous neuromuscular and anatomical structures, including the lumbar spine and sacroiliac joint, any of which can evoke lateral hip pain. Yet the greater trochateric bursa has been historically blamed, and patients are often misdiagnosed with greater trochanteric bursitis when their pain stems from another source.

The following studies suggest alternative causes of this type of hip pain:

  • A study on bursa inflammation versus asymptomatic control subjects. Bursa samples showed no evidence of acute or chronic inflammation of the bursa whatsoever.
  • A fifty patient study conducted in 2014 of patients with greater trochanteric pain found no evidence of inflammation in the greater trochanteric region of any of the patients.
  • A study held in 2013 examined results of ultrasound examination of almost nine hundred patients, which showed no evidence of bursitis. All of the patients had lateral hip pain symptoms.

Why the Source of Lateral Hip Pain Matters

When lateral hip pain is universally assumed to be caused by greater trochanteric bursitis, all cases are then subjected to a similar course of treatment, geared to reducing inflammation. Pain and inflammation are first managed with NSAIDs, followed by cortisone injections, and then on to surgical interventions. Yet physical therapy is rarely considered as treatment for lateral hip pain, even though evidence suggests that bursitis is rarely the primary cause.

Diagnosis is Key to Proper Treatment and Recovery

The sports medicine professionals at NYDNRehab understand human movement science and how mechanical deficiencies can lead to structural pain. They will conduct a comprehensive physical exam, ultrasound imaging and testing for motor deficiencies to get to the bottom of your lateral hip pain. NYDNRehab is committed to not just treating your pain, but to resolving it by getting to the source. Our advanced treatment strategies are cutting edge, geared to getting you back on your feet and physically active again. Call NYDNRehab today, and find out why we are the leading specialists for lateralhip pain in NYC.

Sources:

Long SS, Surrey DE, Nazarian LN. Sonography of Greater Trochanteric Pain Syndrome and the Rarity of Primary Bursitis. American Journal of Roentgenology. 2013; 201(5): 1083-1086. doi:10.2214/AJR.12.10038.

Board TN, Hughes SJ, Freemont AJ. Trochanteric bursitis: the last great misnomer. Hip Int. 2014; 24(6): 610-615. doi:10.5301/hipint.5000154.

Silva F, Adams T, Feinstein J, Arroyo RA. Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol. 2008; 14(2): 82-86. doi:10.1097/RHU.0b013e31816b4471.

130 West 42 Street Suite 1055, New York NY 10036
bg

In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

contact-form-animation
You can call
or Send message