Can sciatica cause point tenderness at the greater trochanter?

Sciatica Does Not Cause Point Tenderness at the Greater Trochanter

Sciatica does not cause point tenderness at the greater trochanter; instead, point tenderness at this location is typically indicative of greater trochanteric bursitis or greater trochanteric pain syndrome (GTPS), which is a distinct clinical entity that can be misdiagnosed as sciatica. 1

Differential Diagnosis Between Sciatica and Greater Trochanteric Pain

• Sciatica is characterized by lower limb pain radiating below the knee and into the foot and toes, caused primarily by herniated lumbar discs 2
• Greater trochanteric pain syndrome presents with:
  • Localized tenderness at the tip of the greater trochanter 3
  • Pain on resisted hip abduction 3
  • Pain radiating to the posterolateral aspect of the thigh (may not extend below the knee) 4
  • Possible paresthesias in the legs 4

Diagnostic Confusion

• Studies show that approximately 10.95% of patients referred for sciatica were actually suffering from greater trochanteric bursitis 1
• An additional 2.74% of patients had both sciatica and coexisting greater trochanteric bursitis 1
• The similarity in pain patterns can create a diagnostic trap for clinicians 1

Diagnostic Approach

• Radiographs should be obtained first to rule out other causes of hip pain 5
• Ultrasound is effective for detecting trochanteric bursitis, though it may be difficult to distinguish from gluteus medius tendinosis 5
• MRI can comprehensively assess peritrochanteric structures including the gluteus minimus and medius muscles, abductor tendons, and the trochanteric bursa 5
• Diagnostic injection with local anesthetic into the trochanteric bursa can provide both diagnostic confirmation and therapeutic benefit 5

Anatomical Considerations

• Avulsion fractures or tendinopathy at muscular attachment sites around the greater trochanter (such as gluteal muscles) can cause local soft-tissue swelling and inflammation that can involve adjacent nerves 6
• This inflammation can affect superior or inferior gluteal nerves, not the sciatic nerve directly 6
• The sciatic nerve runs posterior to the hip joint and greater trochanter, not directly over the greater trochanteric area 2

Clinical Pearls

• Point tenderness at the greater trochanter with pain on resisted abduction strongly suggests GTPS rather than sciatica 3
• Differentiating between trochanteric bursitis and gluteus medius/minimus tendinosis can be challenging, and these conditions frequently coexist 5
• In patients with hip prostheses, extracapsular disease associated with adverse reactions to metal debris could be misinterpreted as trochanteric bursitis 5
• Greater trochanteric pain syndrome is more common in women, and in patients with coexisting low back pain, osteoarthritis, iliotibial band tenderness, and obesity 7

Treatment Considerations

• Most cases of GTPS respond to conservative measures such as physical therapy, weight loss, NSAIDs, and activity modification 7
• Corticosteroid injections into the trochanteric bursa can provide significant symptom relief 5, 4
• Ultrasound guidance improves the accuracy of these injections 5
• Early diagnosis and appropriate treatment of GTPS can prevent unnecessary imaging and inappropriate interventions 1