Initial Management for Lateral Thigh Pain Related to Gluteus Medius

Diagnostic Considerations

• Lateral thigh pain related to gluteus medius typically presents as pain over the greater trochanter, which may radiate to the lateral thigh 1
• Differentiation between gluteus medius tendinopathy and trochanteric bursitis can be difficult, and the two conditions may coexist 1
• MRI is the preferred imaging modality to assess the gluteus medius muscle, abductor tendons, and trochanteric bursa when initial conservative management fails 1
• Ultrasound can identify tendinopathy, partial tears, and complete tears/avulsion of the gluteus medius tendon 1

Initial Management Algorithm

First-Line Interventions

• The American Academy of Orthopaedic Surgeons recommends physical therapy with strengthening exercises, focusing on the hip abductor muscles 2
• The American College of Radiology suggests a regular individualized daily exercise regimen that includes strengthening exercises for both legs, including the quadriceps and proximal hip girdle muscles, aerobic activity and exercise, and range of motion/stretching exercises 4
• Activity modification, such as reducing activities that exacerbate symptoms and implementing the "small amounts often" principle, can help manage pain 4
• NSAIDs can be used for pain management when not contraindicated, as recommended by the American Academy of Orthopaedic Surgeons 2, 5

Assistive Devices and Adaptations

• Consider using walking aids, such as a walking stick on the contralateral side, to reduce pain and increase participation 4
• Wearing appropriate and comfortable shoes can also help manage pain 4
• Assistive technology and adaptations at home or work can reduce pain and increase participation 4

Second-Line Interventions

• If first-line interventions fail, advanced imaging such as MRI can be considered to assess peritrochanteric structures, including the gluteus minimus and medius muscles, abductor tendons, and the trochanteric bursa 1