ROM and hip radiographs are typically normal. Diagnosis is clinical, although there is a spectrum of disorders that present with lateral hip pain. The exact source of pain is often unknown and can be from bone, tendon, or bursa. In patients with trochanteric bursitis, gluteus medius tendinopathy or syndrome should also be considered.
Treatment begins with conservative management—starting with heat and NSAIDs for the first 4 weeks, restriction of repetitive motion, correction of any underlying gait disturbance, and performance of passive stretching exercises. If no improvement occurs, a local corticosteroid injection into the point of maximum tenderness can be therapeutic. It can also be diagnostic for trochanteric bursitis if symptom relief is achieved. One study showed a 90% improvement rate with 1 to 3 injections.21,22 More recent studies show the average improvement in symptom relief is in the range of 70% to 100%, but long-term follow-up varies.20
Is an osteoid osteoma to blame?
Osteoid osteomas are common benign skeletal lesions seen in young adults with hip pain, but may be an incidental finding. The average patient age is 10 to 20 years, with males affected more than females. Pain is the predominant symptom, starting as mild and intermittent and progressing to constant and severe. Night pain is common.23 Other symptoms are swelling, deformity, or limp.
Dramatic relief of pain with aspirin or NSAIDs is a diagnostic sign of osteoid osteoma. Diagnosis is made by radiographs. Treatment is surgical excision of the osteoid osteoma nidus, resulting in a good long-term prognosis.23
CORRESPONDENCE Janna Johanns, MD, Montana Family Medicine Residency, 123 South 27th Street, Billings, MT 59101; joha0198@umn.edu