The article discusses the most common causes of pain at the outer aspect of the hip and the role of imaging in establishing the diagnosis and managing the condition.
What are the causes of pain at the outer aspect of the hip?
Greater trochanteric pain syndrome (Hip trochanteric bursitis)
This is one of the common conditions we see in our practice and a common indication for ultrasound-guided steroid injections in our practice. In this condition, there is pain on the outside of the hip due to inflammation of the trochanteric bursa. "The trochanteric bursa" is a thin fluid-containing sac found outside the hip, next to a bony prominence (called the greater trochanter), hence the condition's name. It is often associated with irritation of the tendons attaching to the greater trochanter (called the gluteal tendons); therefore, this condition is sometimes referred to as “gluteal tendonitis”. Trochanteric pain syndrome is an umbrella term used to describe the different conditions that could affect this area. Please read our article about Trochanteric pain syndrome to find out more. The pain can be more severe after lying on the affected side and crossing the legs. To read more about this condition, please read our article about Hip trochanteric bursitis. A hip ultrasound is very useful for the assessment and confirming the diagnosis. The management of trochanteric bursitis starts with physiotherapy. An ultrasound-guided steroid injection can be very useful in management. Evidence also shows that there is a role for PRP (platelet-rich plasma) injections in the management of hip abductor tendinosis.
Sciatica refers to back pain symptoms that extend into the thigh and leg. This is usually secondary to pressure or pinching of the nerves as they leave the spine, resulting in pain, numbness and sometimes weakness in the leg muscles. The site of symptoms depends on the level of nerve pinching within the spine. If there is pressure upon the L3, L4 or L5 nerves, the pain can be felt at the outer aspect of the hip. To find out more, please see our article about Sciatica.
Other less common causes for pain at the outer aspect of the hip include conditions like meralgia paresthetica. In this condition, there is usually numbness and tingling sensation at the outer aspect of the thigh due to irritation of the lateral cutaneous nerve of the thigh.
Hip conditions and treatments