Diagnostic Assessment for Lateral Hip Pain

Clinical Presentation and Diagnosis

Lateral hip pain is the hallmark of Greater Trochanteric Pain Syndrome (GTPS), distinguishing it from intra-articular hip pathology, which typically presents with anterior groin pain, according to the British Journal of Sports Medicine 1, 2
The absence of groin pain helps exclude diagnoses such as FAI syndrome and labral tears, as noted by the British Journal of Sports Medicine 1, 2
A negative FADIR test (flexion-adduction-internal rotation) helps rule out intra-articular hip pathology, though its clinical utility is limited, as reported by the British Journal of Sports Medicine 1, 3

Imaging alone is not sufficient for diagnosing hip-related pain, and must be combined with symptoms and clinical signs, as emphasized by the British Journal of Sports Medicine 3, 4
Incidental imaging findings are common in asymptomatic individuals and should be managed with appropriate clinical sensitivity, according to the British Journal of Sports Medicine 5, 4
Multiple hip conditions can coexist, such as labral and chondral conditions with FAI syndrome, as noted by the British Journal of Sports Medicine 5, 4

The American College of Radiology recommends starting with AP pelvis and lateral hip radiographs to exclude alternative diagnoses such as osteoarthritis, fractures, or dysplasia 6, 7
Radiographs showing greater trochanter surface irregularities >2mm have poor diagnostic accuracy for GTPS, with only 24.7% positive predictive value 8

MRI of the hip without contrast is recommended to evaluate for abductor tendon tears (gluteus medius and minimus) if the Trendelenburg gait persists or symptoms are refractory to initial conservative treatment 6

Excluding intra‑articular hip pathology and lumbar spine disease is essential before confirming GTPS, ensuring that lateral hip pain is not attributable to conditions such as femoroacetabular impingement, labral tears, osteoarthritis, or L1‑L3 radiculopathy. 9
A negative flexion‑adduction‑internal rotation (FADIR) test helps rule out intra‑articular hip pathology, although its specificity for excluding such conditions is limited. 9, 10

Imaging findings must always be interpreted in conjunction with clinical signs and symptoms; a diagnosis should never be based solely on radiographic or MRI abnormalities. 10, 11
Incidental imaging abnormalities—such as bursal fluid collections or minor tendon signal changes—are frequently observed in asymptomatic individuals, underscoring the need for clinical correlation before attributing these findings to GTPS. 10
Co‑existence of multiple hip pathologies (e.g., GTPS together with mild femoroacetabular impingement morphology) is common, so a comprehensive clinical assessment is required to identify all contributing conditions. 10