šŸ”‘ Key Learning

  • Osteoarthritis presents with pain and reduced internal rotation of the hip.
  • Greater trochanteric pain syndrome presents with lateral hip pain, often worse when lying on the affected side, commonly related to overuse or gluteal tendinopathy.

šŸ¦“ Osteoarthritis of the Hip

  • See separate detailed OA note.
  • šŸ‘€ Clinical features:
    • Joint pain, worsened by activity and relieved by rest
    • Reduced internal rotation is often the first sign
    • Morning stiffness < 30 minutes
    • Antalgic gait

šŸ¦µ Greater Trochanteric Pain Syndrome (GTPS)

šŸ§¬ Pathophysiology

  • Chronic pain over the greater trochanter, related to:
    • Trochanteric bursitis
    • Gluteus medius/minimus tendinopathy or tears
  • Often considered a regional pain syndrome rather than an isolated bursitis

šŸ‘€ Clinical Features

  • Pain over the lateral thigh, buttock, or greater trochanter
  • Worsens with:
    • Lying on affected side (e.g. in bed)
    • Climbing stairs
    • Prolonged standing or walking
  • May come and go, or be constant and gradually progressive

šŸ”Ž Examination

  • Tenderness on palpation of the greater trochanter
  • Trendelenburg test may be positive
  • Antalgic gait common
  • No true joint restriction (distinguishes from OA)

šŸ’Š Management

  • Simple analgesia (e.g. paracetamol or NSAIDs)
  • Activity modification (avoiding aggravating activities)
  • Physiotherapy ā€“ focus on gluteal strengthening
  • Consider peri-trochanteric corticosteroid injection if persistent
  • Refractory cases may need referral to MSK or orthopaedics

šŸ“ Exam Clues & Clinchers

  • Pain over lateral hip + worse when lying on side ā†’ GTPS
  • Groin pain + waddling gait in pregnancy ā†’ Pubic symphysis dysfunction
  • Pain with reduced internal rotation of hip ā†’ Osteoarthritis