What is the recommended treatment plan for a patient with painful right hip, radiating pain down the right thigh lateral aspect, and ultrasound findings of degenerative changes, tendinosis, and bursitis?

Treatment Plan for Right Hip Pain with Tendinosis and Bursitis

The recommended treatment for a patient with right hip pain showing degenerative changes, gluteal tendinosis, and greater trochanteric bursitis should begin with exercise-based therapy for at least 3 months, supplemented with NSAIDs and possibly corticosteroid injection for the greater trochanteric bursitis.

Initial Treatment Approach

• Exercise-based treatment is the first-line therapy for hip-related pain, including tendinosis and bursitis, with strong evidence supporting its effectiveness 1
• The treatment program should last for a minimum of 3 months to achieve optimal outcomes 1
• NSAIDs should be considered as part of the initial management strategy for pain control 2

Specific Interventions for Tendinosis and Bursitis

• For greater trochanteric bursitis, an image-guided corticosteroid injection is appropriate and rated highly (8/9) by the American College of Radiology for managing hip pain 1
• Physical therapy should focus specifically on the gluteus medius and minimus muscles to address the calcific tendinosis identified on ultrasound 2
• Exercise descriptors should be clearly defined, including load magnitude, repetitions, sets, and progression to ensure effective treatment 1

Monitoring and Follow-up

• Patient-reported outcome measures should be used to monitor response to treatment, as recommended with strong consensus (9/9) by clinical guidelines 1
• If symptoms persist after 3 months of conservative treatment, consider MRI without contrast (rated 9/9 by ACR) for further evaluation 1
• Ultrasound can be used for follow-up assessment (rated 7/9 by ACR) to monitor changes in tendinosis and bursitis 1

Addressing Degenerative Changes

• For the degenerative changes at the anterior hip joint with effusion, physical activity should be maintained but modified to avoid exacerbating symptoms 1
• Patient education about the nature of degenerative changes and realistic expectations for improvement is essential 1
• Consider referral to Physical Medicine and Rehabilitation for development of an individualized therapy program targeting the specific findings 2

Common Pitfalls to Avoid

• Relying solely on imaging findings without correlation to clinical symptoms - studies show that peritrochanteric abnormalities on MRI are present in 88% of asymptomatic hips 3
• Proceeding to surgical intervention before exhausting conservative options - guidelines strongly support trying non-surgical approaches first 2
• Failing to address all components of the condition - treatment should target both the tendinosis (gluteus medius/minimus, rectus femoris, tensor fascia lata) and the bursitis 4

Treatment Algorithm

1. First 4-6 weeks:

   • Begin NSAIDs for pain control
   • Initiate physical therapy focusing on gluteal strengthening
   • Consider corticosteroid injection for greater trochanteric bursitis if pain is severe

2. Weeks 6-12:

   • Progress exercise intensity as tolerated
   • Reassess pain and function using standardized outcome measures
   • Modify activities to avoid symptom exacerbation

3. After 12 weeks:

   • If significant improvement: continue maintenance exercise program
   • If limited improvement: consider advanced imaging (MRI without contrast) and specialist referral 1