Greater Trochanteric Pain Syndrome: Abductors, External Rotators
Chronic pain and tenderness at the greater trochanter characterizes trochanteric pain syndrome. For a long time, trochanteric bursitis was thought to be the only underlying pathology; however, investigations have shown that tendinopathy of the abductors is the main cause, followed by iliotibial band thickening and, to a lesser extent, abductor tendon tears. Trochanteric bursitis can be associated with it. On magnetic resonance imaging (MRI), peritrochanteric T2 abnormalities are evident in greater trochanteric pain syndrome. However, this is also frequently encountered in asymptomatic patients. In the postoperative setting, patients with total hip arthroplasties and transtendinous lateral or posterior surgical access are prone to tendon injury. Symptomatic patients typically present with tendon tears, whereas peritrochanteric fluid, thickening, and signal alterations of the abductors and fatty atrophy of the gluteus minimus muscle are often encountered in asymptomatic postoperative hips. MRI and ultrasound are proven and reliable imaging modalities in patients with greater trochanteric pain syndrome. Awareness of typical imaging findings, in particular in postoperative patients, are helpful in the evaluation of patients.