Stephen Bird

Interesting cases Diane.

The way I think about fluid in the trohanteric bursa is not surprisingly similar to how I think about fluid in the subacromial sub deltoid bursa. In both joints when I see thickening of the bursa which represents synovial proliferation I think of bursitis. When I see frank fluid I am on the hunt for a tear. The only difference is the gluteus minimus and medius tendons are not only like to fail at the enthesis like supraspinatus, but also like to fail at their MTJ.

In your first case I am not actually convinced it is fluid and would like to suggest the possibility that it is some fat in the plane between G-Max and the deep lateral rotators of the hip. I think this due to the texture of the area and also the way it moves on dynamic assessment.
I may well be wrong but that is my first impression.

The second are looks like significant synovial proliferation and I would simply call this a good case of bursitis. I a happy it is in the right plane. There may be a trace of fluid but I think it is mainly synovial proliferation.

The manoeuvre doesn’t have a particular name as far as I know, but I call it a “reverse clam” as with a clam you keep the ankles together and seperate the knees and this is the opposite to that !


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