Lateral hip pain: findings from magnetic resonance imaging and clinical examination.
METHODS
Prospective cross-sectional study.


OBJECTIVE
To examine the radiological and physical therapy diagnoses of lateral hip pain (LHP), and determine the validity of selected clinical variables for predicting gluteal tendon pathology.


BACKGROUND
LHP is frequently encountered by clinicians. Further investigation is required to establish the specific pathologies implicated in the cause of LHP, and which clinical tests are useful in the assessment of this problem.


METHODS
Forty patients with unilateral LHP underwent a physical therapy examination followed by magnetic resonance imaging (MRI) studies. Three radiologists analyzed the images of both hips for signs of pathology. Interobserver reliability of the image analyses, the agreement between the physical therapy and radiological diagnoses, and the validity of the clinical tests were examined.


RESULTS
Gluteus medius tendon pathology, bursitis, osteoarthritis and gluteal muscle atrophy (predominantly affecting gluteus minimus) were all implicated in the imaging report of LHP. While prevalent in symptomatic hips, abnormalities were also identified in asymptomatic hips, particularly relating to the diagnosis of bursitis. The strength of agreement between radiologists was variable and little agreement existed between the physical therapy and radiological diagnoses of pathology. Nine of the 26 clinical variables examined in relation to gluteal tendon pathology had likelihood ratios above 2.0 or below 0.5, but the associated 95% confidence intervals were large.


CONCLUSIONS
The diagnosis of LHP is challenging and our results highlight some problems associated with the use of MRI as a diagnostic reference standard. This factor, together with the imprecise point estimates of the likelihood ratios, means that no firm conclusions can be made regarding the diagnostic utility of the clinical tests used in the assessment of gluteal tendon pathology.
Department of Anatomy and Structural Biology, University of Otago, Dunedin, New Zealand. stephanie.woodley@anatomy.otago.ac.nz
Stephanie J
SJ
Woodley
Helen D
HD
Nicholson
Vicki
V
Livingstone
Terence C
TC
Doyle
Grant R
GR
Meikle
Janet E
JE
Macintosh
Susan R
SR
Mercer
D000328:Adult; D000368:Aged; D002062:Bursitis / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D020918:Complex Regional Pain Syndromes / Q000209:etiology / Q000473:pathology*; D005260:Female; D006621:Hip Joint / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D009133:Muscular Atrophy / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D015207:Osteoarthritis, Hip / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D010808:Physical Examination; D052256:Tendinopathy / Q000150:complications / Q000175:diagnosis / Q000473:pathology*