TABLE 1: LATERAL HIP AND THIGH PAIN: THEORETICAL AND PRAGMATIC UNDERPINNINGS OF ALGORITHM RECOMMENDATIONS
 
   

Table 1: Lateral hip and thigh pain:
Theoretical and pragmatic underpinnings
of algorithm recommendations

 
   


Algorithm component Comments References

Greater Trochanteric Pain Syndrome (GTPS)

GTPS diagnostic criterion Pain over the greater trochanter is best classified as a syndrome because multiple etiologies can lead to pain at the lateral hip [8]

GTPS commonly coexists with chronic low back pain Greater trochanteric tenderness was present in 44.9% of people with chronic low back pain, versus in 6.0% of controls [12]

Trendelenburg sign — description Trendelenburg’s sign is positive if, during single-leg stance on the affected leg, the contralateral pelvis drops and/or the trunk shifts toward the stance leg [30]

Trendelenburg sign is common in people with chronic low back pain Trendelenburg sign was positive in 54% of people with chronic low back pain versus 9.7% of controls [12]

Corticosteroid injection is
not first-line treatment
An ultrasound study of 877 patients and an MRI study of 174 patients demonstrated that only approximately 20% of GTPS cases had true bursitis (i.e., inflammation). Additionally, corticosteroid injections are toxic to local tendon tenocytes and potentially contribute to further weakening of tendons [9,10],
[17–20]

Hip abduction strengthening is first-line treatment In 229 patients, at 15 months gluteal strengthening (80% success rate) was superior to corticosteroid injection (48% success rate) [16]

Iliotibial Band Syndrome (ITBS)

ITBS commonly co-exists with GTPS Odds ratio of 2.54 [8]

Ober’s test—reliability Inter-rater reliability was 97.6%, and intra-rater reliability was 90% [24,25]

Hip abduction strengthening is first-line treatment for ITBS In a prospective trial, 22/24 runners treated with hip abductor strengthening were pain-free at 3 months [27]

Hip Osteoarthritis (OA)

Pain from hip OA can refer
to the lateral hip
Symptomatic hip OA presented as lateral hip pain in 27% of patients [7]

Lumbar radicular pain

Lumbar radicular pain can refer to the lateral hip and thigh In 48 subjects with lumbar disc herniation, 33% experienced pain in the lateral thigh and 46% had a herniation at the L1-2, L2-3, or L3-4 level [29]

Seated slump test — sensitivity and specificity For lumbar disc herniations, the seated slump test had a sensitivity of 0.84 and specificity of 0.83, which was overall superior to the straight leg raise test, which had a sensitivity of 0.52 and specificity of 0.89 [31]

McKenzie therapy for radiculitis A positive pain response to repeated end-range lumbar motion (i.e., McKenzie therapy/mechanical diagnosis and treatment) predicted a positive response to non-operative care [39]

Oral corticosteroids for radicular pain In a randomized, double-blind, placebo-controlled trial of 269 patients with a lumbar disc herniation, a short course of oral corticosteroids resulted in modestly improved function but no improvement in pain [40]

Lumbar Spinal Stenosis (LSS)

Pain from lumbar spinal stenosis can refer to the lateral hip and thigh In 50 subjects with lumbar spinal stenosis, 42% experienced pain in the lateral thigh [29]

GTPS = greater trochanteric pain syndrome
ITBS = iliotibial band syndrome
OA = osteoarthritis.


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