A patient reports severe pain over the greater trochanter that worsens with walking; palpation elicits tenderness over the greater trochanter. The MOST likely diagnosis is:

A patient reports severe pain over the greater trochanter that worsens with walking; palpation elicits tenderness over the greater trochanter. The MOST likely diagnosis is:

• A. Sacroiliac joint derangement
• B. A hip fracture
• C. A strain of the adductor longus muscle
• D. Hip bursitis

Answer: (D)

Pain localized to the greater trochanter with tenderness on palpation points to inflammation of the trochanteric (hip) bursa. When this bursa inflames from overuse or friction during walking, you get sharp lateral hip pain that worsens with weight bearing and pinpoint tenderness over the greater trochanter. This is classic for hip bursitis. Other possibilities don’t fit as well: a hip fracture would generally present with sudden, severe pain after trauma and often an inability to bear weight; sacroiliac joint issues tend to produce pain in the lower back or buttock with more diffuse, nonfocal tenderness; a strain of the adductor longus causes groin pain near the pubic area and tenderness there, not over the greater trochanter.

Pain localized to the greater trochanter with tenderness on palpation points to inflammation of the trochanteric (hip) bursa. When this bursa inflames from overuse or friction during walking, you get sharp lateral hip pain that worsens with weight bearing and pinpoint tenderness over the greater trochanter. This is classic for hip bursitis. Other possibilities don’t fit as well: a hip fracture would generally present with sudden, severe pain after trauma and often an inability to bear weight; sacroiliac joint issues tend to produce pain in the lower back or buttock with more diffuse, nonfocal tenderness; a strain of the adductor longus causes groin pain near the pubic area and tenderness there, not over the greater trochanter.