Trochanteric Impingement

[John Garland]

Hi peoples,
I received a call from sonographer with a referral for U/S imaging of hip on patient with THR 20 years prior , querying Trochanteric Impingement , with dynamic assessment , from an Orthoppaedic surgeon.
My initial thought was Iliopsoas impingement on THR causing bursitis or frictional pain.
Mr Bird thought it more likely referring to a frictional type syndrome involving ITB and GT(similar to a clicking hip I imagine) Dynamically testing by knees and hips flexed together , then raising the affected legs ankle whilst scanning.
Has anyone came across a similar referral or have knowledge of Trochanteric Impingement?
I didn’t get any clinical notes.
Regards
John
PS Merry Christmas to all.

[Stephen Bird]

Hi John,

The lesser trochanter is the insertion point of iliopsoas so there cannot really be any friction problem here. In fact the insertion of iliopsoas is a nice benign area and not often a cause of pain. The lesser trochanter can cause ischiofemoral impingement of the quadratus femoris muscle between the lesser trochanter and the ischial tuberosity. It is really an MRI diagnosis as we don’t see the muscle oedema with ultrasound. What I think they are looking for is a friction problem between the iliotibial band and the greater trochanter / G-min /G-med tendons. During a hip replacement the ITB is cut through to gain access and then sewn back up. After the surgery some suture material or scar tissue may cause friction and lead to a trochanteric bursitis and pain. I do use a dynamic manoeuvre. Lay the patient decubitus. Gently flex their knees and hips. Keep their knees together and lift the uppermost ankle towards the roof. You can observe the dynamic movement of the friction plane where the trochanteric bursa lives. It is a great trick.

Steve

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