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Lateral Hip Pain

Common causes for Lateral Hip Pain:

  • GTPS (Greater Trochanteric Pain Syndrome) (pain in region of greater trochanter)
  • Gluteus medius tendinopathy (inflammation and weakness of the gluteus medius muscles which may contribute to GTPS)
  • External snapping hip – (a visible ‘flicking’ of the iliotibial band over the greater trochanter)
History – GTPS and Gluteus medius tendinopathy  History – External snapping hip
Most common in middle age womenMost common in young females
Worsened by obesityPoor underlying conditioningLikely to be associated with weakness of hip musculature
Excessive & frequent loads to outside of hip joint eg sitting cross leggedMay be associated with hypermobility
Possible history of trauma to lateral aspect of hip 
  
Signs – GTPS and Gluteus medius tendinopathy  Signs – External snapping hip
Specific lateral hip pain – see photosVisible/reported flicking or clicking located in region of Greater trochanter
Sore to lie on affected sidePain located to lateral hip
Worse with legs crossedPatients may report hip ‘clicking out’
Pain going up and down the stairs 

Who can refer:

GPs, GPAPPs, other Consultants

Who to refer:

Patients with history and signs as above who have not responded to or exhausted all conservative treatments including 4-6 months of specific strengthening exercises. Local corticosteroid injection could possibly be considered but is not the first line of treatment.

Who not to refer:

Referred pain from lumbar spine – consider referral to NHS Lothian Integrated Back Pain Service

Hip OA seen on XR

Red flags – see home page

How to refer:

SCI gateway > Lauriston Buildings > Orthopaedics – Other

Please request an AP pelvis XR before referral

Primary care investigations

XR AP pelvis to rule out OA hip and look for calcification around greater trochanter

Primary care treatment

Physiotherapy referral

Information sheet on postures & positions to avoid

Weight loss advice/management

Consider corticosteroid injection locally to greater trochanter bearing in mind inflammation is not likely to be the main source of pain