Lateral Hip Pain: Ultrasound Scanning Protocol
For lateral hip pain, ultrasound should focus on the greater trochanteric region, specifically evaluating the trochanteric bursa, gluteus medius and minimus tendons, and the iliotibial band. 1
Primary Anatomical Targets for US Evaluation
The lateral hip contains several structures that commonly cause pain and are well-visualized with ultrasound:
- Greater trochanteric bursa - the primary target when trochanteric bursitis is suspected 1, 2
- Gluteus medius and minimus tendons - these abductor tendons attach to the greater trochanter and are frequently torn or tendinopathic in patients presenting with lateral hip pain 1, 2, 3
- Iliotibial band - can contribute to lateral hip pain through friction over the greater trochanter 4, 5
Clinical Context and Diagnostic Approach
Why Ultrasound for Lateral Hip Pain?
Ultrasound is specifically recommended by the American College of Radiology for evaluating extra-articular soft tissue abnormalities such as tendonitis and trochanteric bursitis 1. The key advantages include:
- Real-time dynamic assessment - allows evaluation of snapping hip and tendon movement 1
- Guidance for therapeutic injections - ultrasound-guided corticosteroid injections into the trochanteric bursa improve accuracy 2
- Differentiation of pathology - though distinguishing trochanteric bursitis from gluteus medius tendinosis can be challenging, as these conditions frequently coexist 2, 3
Initial Imaging Recommendation
Radiographs should always be obtained first before ultrasound to rule out other causes of hip pain such as arthritis, fractures, or bone tumors 1, 2. Standard views include anteroposterior pelvis and lateral femoral head-neck radiographs 1.
Common Pitfalls and Clinical Pearls
Diagnostic Challenges
- Coexisting pathology - trochanteric bursitis and gluteus medius/minimus tendinosis frequently occur together, making differentiation difficult even with ultrasound 2, 3
- Hip prosthesis patients - in patients with total hip replacements, extracapsular disease from adverse reactions to metal debris can mimic trochanteric bursitis and should not be confused 2, 6
- Referred pain - always screen for lumbar spine pathology, as lateral hip pain can be referred from spinal sources 1, 4
When to Consider MRI Instead
MRI provides more comprehensive assessment of peritrochanteric structures and should be considered when 1:
- Ultrasound findings are equivocal
- Surgical intervention is being considered
- Complete evaluation of the gluteus medius and minimus muscles and tendons is needed
- Symptoms persist despite conservative treatment
Clinical Presentation
Typical findings in lateral hip pain include 4, 5, 7:
- Point tenderness over the posterolateral greater trochanter
- Pain radiating along the lateral thigh to the knee
- Weakness of hip abduction
- Pain worse with lying on the affected side
The diagnosis should never be made on imaging alone - it must be combined with clinical symptoms and physical examination findings 1.