Ultrasound Scanning for Lateral Hip Pain
For lateral hip pain, scan the greater trochanteric region using anterior longitudinal and transverse views to evaluate the gluteus medius and minimus tendons, trochanteric bursa, and surrounding soft tissues. 1
Primary Scanning Technique
The anterior longitudinal scan parallel to the femoral neck is the most valuable view for detecting pathology in lateral hip pain, including:
- Gluteus medius and minimus tendon tears 1
- Trochanteric bursitis and bursal distension 1, 2
- Tendinopathy of the hip abductor mechanism 3, 4
After obtaining the anterior longitudinal scan, perform an anterior transverse scan with 90° rotation to complete the examination 1.
Specific Anatomical Targets
Greater trochanteric region is the primary focus for lateral hip pain, as this area contains the most common pain generators:
- The gluteus medius and minimus tendons insert on the greater trochanter and are frequently torn or tendinopathic in patients presenting with lateral hip pain 5, 2
- The subgluteal (trochanteric) bursa lies between these tendons and the greater trochanter 2, 4
- The tensor fascia lata and iliotibial band can cause impingement and frictional trauma to underlying structures 2, 4
Patient Positioning
Position the patient supine with the hip in neutral position for initial scanning 1. Dynamic examination with internal and external rotation may help identify tendon pathology and impingement 3.
Critical Limitations to Recognize
Ultrasound has significant limitations for lateral hip pain evaluation and should not be used as the sole imaging modality. The ACR states there is insufficient evidence to support US as the primary imaging study for suspected tendon, muscle, or ligament injury around the hip 1. Specific limitations include:
- Sensitivity of only 79% for detecting gluteus medius/minimus tendon tears in chronic greater trochanteric pain syndrome 1
- Only 58.3% detection rate for proximal hamstring avulsions compared to 100% with MRI 1
- Limited ability to assess deep intra-articular structures 6
Recommended Clinical Algorithm
Always obtain plain radiographs first (AP pelvis and lateral hip views) before ultrasound, as these are mandatory initial imaging rated 9/9 for appropriateness by the ACR 1, 6. If radiographs are negative but clinical suspicion remains high for tendon pathology:
- MRI without contrast is the definitive study, with 93% sensitivity and 92% specificity for gluteus medius/minimus tears 1
- Ultrasound can be used for real-time guidance of diagnostic/therapeutic injections into the trochanteric bursa or peritendinous areas 6, 3
Common Diagnostic Pitfalls
Do not assume trochanteric bursitis is the sole diagnosis without evaluating for associated gluteus medius/minimus tendon tears, which frequently coexist and may be the primary pathology 5, 2. The presence of moderate to severe lumbar degenerative disease predicts poor response to local injection and suggests referred pain rather than isolated lateral hip pathology 7.