The hip, the hip; no wait, it is the Greater Trochanter. Anytime someone says that he/she has “hip” pain I always question where exactly she/he is talking about. Nine times out of ten the area of pain is not the actual hip joint, but rather the Greater Trochanter.
The Greater Trochanter is at the top of the femur, on the side (see Picture, the green pen is pointing to the Greater Trochanter). The actual hip joint lies deep within the pelvis, near the pubic bone (see picture, the pink pen is pointing to the hip joint). Distinguishing between the two areas of potential pain is very important to arrive at the correct diagnosis and treatment plan.
Why would the Greater Trochanter become painful? I can think of six reasons: 1) Quadratus Femoris 2) Gluteus Medius 3) Piriformis 4) Gluteus Minimus 5) Obturator Internus 6) Obturator Externus. These six muscles all attach to the Greater Trochanter and these insertion points can become inflamed and painful (called tendonitis). Another reason that the area of the Greater Trochanter can become painful is called bursitis. A bursa allows freedom of movement and cushioning for the tendon as it passes over a bone. This bursa can also become inflamed and painful—bursitis. Greater Trochanter pain is not a sign of hip joint arthritis because the hip joint is in a totally separate area. For this reason, Greater Trochanter pain is treated differently than hip joint pain.
Thus ends the anatomy lesson.