Hip Girdle Pain

Pain around the hip girdle is a common complaint in clinical practice. Patients with pain resulting from diseases of the hip joint usually describe pain in the anterior thigh or inguinal region that worsens with weight bearing. More commonly, patients with a chief complaint of hip pain have a problem in one of the nonarticular structures of the hip girdle, usually located posteriorly or laterally [see Table 1]. A multitude of bursae have been described in the hip girdle region. Pain in the upper buttock in and around the gluteal muscles is often referred to as myofascial hip pain or gluteal bursitis. Pain in this area is often difficult to differentiate from referred lumbar pain. Local therapy with heat, stretching, or glucocorticoid injection is usually helpful, but many patients require long-term therapy.

Trochanteric Bursitis (Greater Trochanteric Pain Syndrome)

Trochanteric bursitis is probably the most common cause of hip girdle pain, although a recent study using MRI suggests that most patients with this pain syndrome may have tendinitis or a partial tear of the gluteus medius tendon.^[44]Patients typically complain of pain over the lateral aspect of the hip girdle, sometimes radiating down the thigh, that is worse at night when they lie on the affected side. Pain is sometimes present when the patient arises from a chair, but it tends to improve with ambulation. Point tenderness over the lateral or posterior aspect of the greater trochanter is usually diagnostic, though some patients with referred lumbar facet or disk disease may have a similar presentation. Patients with more severe pain may have a positive Trendelenburg sign on physical examination. Local heat and NSAIDs may be helpful, and a local glucocorticoid injection is curative in most patients. In refractory cases, repeated injections, physical therapy, and, in rare instances, surgical excision of the bursa may be indicated.

Ischiogluteal Bursitis

Ischiogluteal bursitis results from an irritation of the bursa in the area of the attachments of the hamstring and gluteal muscles at the ischial tuberosity. The condition may be brought on by prolonged sitting or by pressure in the area and usually responds to local heat, stretching, or glucocorticoid injection.

Iliopectineal Bursitis

Iliopectineal bursitis, which is caused by irritation of the bursa between the iliopsoas muscle and the inguinal ligament, is an uncommon cause of inguinal pain and may mimic true hip joint disease. The diagnosis is suggested by the presence of inguinal pain that is aggravated by extension of the hip (in a patient whose hip x-ray is normal). Confirmation by ultrasonography or CT scanning may be required. Treatment is usually with local measures or, in rare cases, by means of surgical excision.

Meralgia Paresthetica

Meralgia paresthetica is characterized by intermittent paresthesia, hypoesthesia, or hyperesthesia over the upper anterolateral thigh. The syndrome is caused by an entrapment of the lateral femoral cutaneous nerve at the level of the anterosuperior iliac spine where the nerve passes through the lateral end of the inguinal ligament. Causes include local trauma, rapid weight gain, and the wearing of constrictive garments around the hips. Useful therapies include avoidance of pressure in the area, weight loss, and local infiltration of glucocorticoids at the level of nerve exit.

Table 1. Differential Diagnosis of Hip Girdle Pain

Clinical Syndrome	Location of Pain	Diagnostic Features and Comments
Acetabular joint pain	Anterior hip (inguinal)	Worse with weight bearing Radiographic confirmation
Ileopectineal bursitis	Anterior hip (inguinal)	Pain with extension Normal radiograph ? Ultrasound or CT scanning
Meralgia paresthetica	Anterior hip (midthigh)	Numbness and tingling Normal hip movement
Trochanteric bursitis	Lateral hip, posterior hip, or both	Normal hip movement Point tenderness Relief with glucocorticoid injection
Myofascial pain	Posterior hip	Localized tenderness Relief with glucocorticoid injection ? Mimics lumbar disease
Gluteal bursitis	Posterior hip	Localized tenderness Relief with glucocorticoid injection ? Mimics lumbar disease
Ischiogluteal bursitis	Posterior hip	Normal hip movement Point tenderness

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