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Tendinopathy and bursitis of the gluteal insertion is another common disorder of the middle aged and elderly. It also occurs in younger more athletic patients perhaps as a consequence of core imbalance. There are several components to these conditions, the relationship of which have yet to be fully elucidated. Although many of these patients are considered to have “trochanteric bursitis”, true trochanteric bursitis is less common than disorders of the gluteus medius tendon and sub gluteus medius bursa. The gluteus medius tendon inserts onto the greater trochanter, with two insertions one to the superior facet and one to the lateral. Deep to the tendon is the sub gluteus medius bursa. Gluteus minims inserts anteriorly and also has its own bursa. It should also be noted that not all abnormalities detected in this region are symptomatic. It is not uncommon to identify a small quantity of fluid in the region of the gluteus medius insertion. Sometimes this is well defined and clearly contained in a bursal structure, on other occasions it is poorly defined and difficult to locate precisely anatomically. Some of these areas of increased signal may reflect true gluteus medius tendinopathy. It is therefore mandatory that positive imaging findings in this region are correlated with clinical symptoms.
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The trochanteric bursa is the most superficial and posterolateral of the many bursa that surround the hip joint. When distended it is easily appreciated on axial T2 weighted images particularly with fat suppression. It lies just below the level of the top of the greater trochanter and deep to the gluteus maximus and iliotibial band. It is a large bursa and can extend significantly laterally and inferiorly. The other commonly involved bursa is the sub gluteus medius bursa. This bursa lies on the deep surface of the gluteus medius insertion. It is also very easily appreciated on axial T2 weighted images particularly with fat suppression. It lies in a more superior location than the trochanteric bursa, and because it is a deeper structure two separate layers of soft tissue are identified lateral to it. The more superficial of these is the iliotibial band once again and the deepest structure is the sub gluteus medius tendon. There has been little work quantifying the relative importance of the sub gluteus medius and trochanteric bursa in patients with lateral hip pain. In the authors experience, if tenderness is more commonly located just above the greater trochanter rather than below and posterior to it. This might suggest that sub gluteus medius bursitis and associated gluteus medius tendinopathy is more common than true trochanteric bursitis.
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