Atypical femoral fracture as the cause of greater trochanteric pain syndrome - a case report

Greater trochanteric pain syndrome may be caused by atypical femoral fractures, and this should be taken into consideration in the diagnostic workout. A 63-year-old woman was referred to our orthopedic outpatient hip clinic with a history of greater trochanteric pain syndrome without known trauma for 1 year. Initially X-ray of the hip and magnetic resonance imaging were found without pathology, and she was given a diagnosis of gluteus medius tendinopathy. As physiotherapy and steroid injections did not resolve her pain, a second look on the magnetic resonance imaging and X-ray revealed a discrete atypical femoral fracture in the lateral cortex with the presence of an isolated Looser zone, which were attributed to her pain syndrome. Two years after onset of symptoms, and with no pain relief on medical treatment, she was treated with an intramedullary nail. One-year postoperative the patient was pain free. This case emphasizes the important utility of magnetic resonance imaging in refractory greater trochanteric pain syndrome.