Point Tenderness at the Greater Trochanter in Lumbar Radiculopathy
Yes, point tenderness at the greater trochanter can occur with lumbar radiculopathy, as the two conditions can coexist or lumbar radiculopathy can be misdiagnosed when greater trochanteric pain syndrome (GTPS) is the actual cause of symptoms.
Relationship Between Lumbar Radiculopathy and Greater Trochanteric Pain
- Greater trochanteric pain syndrome (GTPS) can mimic the symptoms of lumbar nerve root compression, leading to diagnostic confusion 1
- GTPS is characterized by pain and reproducible tenderness in the region of the greater trochanter, buttock, or lateral thigh - areas that may overlap with radicular pain patterns 1
- In a study of patients referred to orthopedic spine specialists for low back pain, 20.2% were found to have GTPS, indicating significant overlap or misdiagnosis between these conditions 1
Differential Diagnosis Challenges
- GTPS is frequently missed in patients with suspected lumbar radiculopathy, with 54.9% of GTPS patients having undergone MRI examinations before proper diagnosis 1
- 62.7% of patients with GTPS had been previously evaluated by orthopedists or neurosurgeons for presumed spinal pathology 1
- Some patients have even undergone unnecessary lumbar spine surgery when GTPS was the actual cause of their symptoms 1
Clinical Examination Findings
- Point tenderness at the greater trochanter and pain on resisted hip abduction are key clinical signs of GTPS that can help differentiate it from true radiculopathy 2
- In patients with lumbar radiculopathy, referred pain patterns may include the greater trochanteric region, creating diagnostic confusion 3
- Ultrasound can be used to detect trochanteric bursitis, which may coexist with gluteus medius tendinosis 4
Mechanisms and Relationships
- A recent study found that in patients with lumbar degenerative disc disease, 79.5% experienced increased pain in the hip region postoperatively, suggesting a relationship between spinal pathology and greater trochanteric pain 3
- Pain catastrophizing and altered pain modulation appear to contribute to pain intensity in patients with painful lumbar radiculopathy, potentially explaining why some patients develop greater trochanteric pain while others do not 5
- Timely detection of GTPS among patients with suspected lumbar radiculopathy can influence treatment tactics and may help avoid unnecessary surgical interventions 3
Diagnostic Approach
- MRI can be used to assess peritrochanteric structures including the gluteus minimus and medius muscles, abductor tendons, and the trochanteric bursa in patients with suspected combined pathology 4
- Diagnostic injection with local anesthetic at the greater trochanter can help confirm GTPS and differentiate it from radiculopathy 1
- Radiculopathy typically presents with positive nerve tension signs and neurological deficits, while GTPS presents with localized tenderness and pain on resisted abduction 2
Management Considerations
- If trochanteric bursitis is thought to be a source of pain, the bursa may be injected with lidocaine alone as a diagnostic test, or in combination with a corticosteroid 4
- In patients with confirmed GTPS accompanying lumbar radiculopathy, treating both conditions is important for optimal outcomes 3
- Ignoring the symptoms of GTPS in the preoperative period can lead to pain intensification in the greater trochanter after surgery for degenerative diseases of the spine 3
Clinical Pitfalls to Avoid
- Avoid attributing all lateral hip and leg pain to lumbar radiculopathy without examining the greater trochanteric region 1
- Be aware that GTPS is more common in middle-aged women, which may help guide diagnostic suspicion 1
- Recognize that extracapsular disease associated with adverse reactions to metal debris (ARMD) in patients with hip replacements could be misinterpreted as trochanteric bursitis 4
- Consider that radiculopathy and GTPS may coexist, requiring treatment of both conditions for optimal outcomes 3