Dr. Michael Kushner

Hip

Greater trochanteric pain syndrome y dolor lateral hip pain

Pain on the outer side of the hip — right over the bony prominence at the side, the greater trochanter — is very common and is often mistaken for a joint problem when in fact it almost always lies outside the joint. The commonest causes are trochanteric bursitis (inflammation of a gliding bursa) and, above all, gluteal tendinopathy (degeneration of the tendons that insert there). It can also be referred from the lumbar spine.

The typical patient reports pain on lying on that side, climbing stairs, walking long distances or standing up after sitting. It is diagnosed on examination and, if needed, with ultrasound or MRI.

The great majority improve without surgery: physiotherapy focused on strengthening the glutes, correcting gait mechanics, pain control and, in selected cases, guided injections. What matters is a precise diagnosis, because treating the tendon is different from treating the bursa or a spinal problem.

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Dr. Kushner’s approach: most of these lateral hip pains do not need surgery; they need a correct diagnosis and a well-directed strengthening programme. Surgery is reserved for the few cases that do not respond.

What if the pain is coming from somewhere else?

Hip and spine are often confused. Answer six questions and bring the summary to your appointment. (In Spanish.)

Hip or spine?

When to seek care without waiting

What it gets confused with

FindingGluteal tendinopathyHip osteoarthritisLumbar spine
Where it hurtsSide of the hip, tender to one fingerGroinLow back and buttock
Characteristic signIt hurts to lie on that sideIt hurts to put shoes onIt hurts after walking a distance
On palpationVery tender over the trochanterNot tender to touchNot tender to touch
Hip rotationPreservedLimited and painfulPreserved

Frequently asked questions

Is it hip osteoarthritis?

Almost never. Lateral pain usually comes from the tendons or the bursa, not from the joint cartilage, which hurts more in the groin.

Does an injection cure it?

It helps control pain in selected cases, but the underlying treatment is strengthening and correcting mechanics.

How long does it take to improve?

This is a tendon problem, and tendons respond slowly: progressive loading programmes are measured in months, not weeks. Consistency matters more than intensity.

Should I just have an injection?

A trial compared corticosteroid injection, a programme of education and exercise with load modification, and simple observation. The injection relieves pain quickly, but the exercise programme holds the result better over time.

Can I sleep on that side?

Early on it is best avoided, and a pillow between the knees helps when sleeping on your side. Crossing your legs and standing with your weight on one hip also compress the tendon.

References

  1. Mellor R, et al. Exercise and load modification versus corticosteroid injection versus wait and see for persistent gluteus medius/minimus tendinopathy (LEAP trial). BMC Musculoskelet Disord. 2016;17:196. DOI
  2. Devin CJ, et al. Hip-spine syndrome. J Am Acad Orthop Surg. 2012;20(7):434-442. DOI
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Reviewed by Dr. Michael David Kushner Shrem, orthopaedic and hip, pelvis and trauma surgeon in Panama. AO Foundation Faculty and Education Chair of AO Panama, fellowship-trained at Hadassah Ein Karem Hospital (Hebrew University of Jerusalem).

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Book a consultation with Dr. Kushner at COMEDSA. Bring any previous imaging for a complete assessment.

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Educational information reviewed by Dr. Michael Kushner Shrem. It does not replace an in-person medical assessment.