From the Guidelines
Ultrasound (US) or Magnetic Resonance Imaging (MRI) without IV contrast is the most appropriate imaging modality to diagnose trochanteric bursitis, with both being equivalent alternatives. According to the most recent and highest quality study [ 1 ], in the setting of a hip arthroplasty patient with trochanteric pain that has been evaluated with radiography, US hip or MRI hip without IV contrast is usually appropriate for suspected abductor injury, or trochanteric bursitis, or other soft tissue abnormality.
Key Points to Consider
- MRI can clearly visualize the soft tissues around the hip, including the bursa, and can detect inflammation, fluid accumulation, and any associated tendon or muscle abnormalities [ 1 ].
- Ultrasound can show fluid in the bursa and thickening of the bursal wall, which are indicative of bursitis [ 1 ].
- X-rays are not typically useful for diagnosing trochanteric bursitis directly, but they may be ordered to rule out other conditions that can cause similar symptoms, such as hip osteoarthritis or fractures.
- Imaging is not always necessary to diagnose trochanteric bursitis, and a clinical examination by a healthcare provider, including a detailed history and physical examination, can be sufficient for diagnosis [ 1 ].
Additional Considerations
- The choice between US and MRI may depend on local preference and expertise [ 1 ].
- It's essential to note that the diagnosis of trochanteric bursitis should prioritize morbidity, mortality, and quality of life as the outcome, and the imaging modality chosen should be based on the most recent and highest quality evidence available [ 1 ].
From the Research
Imaging Modalities for Diagnosing Trochanteric Bursitis
- Various imaging modalities can be used to diagnose trochanteric bursitis, including plain radiographs, bone scans, and MRI 2.
- MRI is particularly useful in confirming the diagnosis and excluding other aetiologies, with STIR sequences demonstrating abnormal increased signal in the trochanteric bursae bilaterally 2.
- Peritrochanteric fluid and abductor tendon abnormality are common MRI findings in trochanteric pain syndrome, but these findings are not exclusive to patients with trochanteric pain 3.
- Ultrasound studies have also been used to evaluate trochanteric bursitis, and have brought into question the idea that bursitis is the primary cause of trochanteric pain 4.
Characteristics of Imaging Findings
- Peritrochanteric T2 abnormalities are common in both patients with and without trochanteric pain, and are not a reliable predictor of trochanteric pain syndrome 3.
- Gluteus tendinopathy is more common in patients with trochanteric pain, and is a significant finding on MRI 3.
- The size, shape, and location of peritrochanteric T2 abnormalities do not differ significantly between patients with and without trochanteric pain 3.