Greater trochanteric pain syndrome

Overview

Greater trochanteric pain syndrome (GTPS) is a common musculoskeletal condition characterized by pain over the lateral aspect of the hip, near the bony prominence known as the greater trochanter of the femur. Formerly referred to as trochanteric bursitis, the term GTPS more accurately encompasses a group of disorders affecting the soft tissues around the greater trochanter, including tendinopathies of the gluteus medius and minimus, iliotibial band irritation, and bursitis. GTPS is more common in middle-aged and older adults, especially women, and may significantly affect mobility and quality of life.

Causes

GTPS results from inflammation, degeneration, or irritation of the soft tissues around the greater trochanter. Contributing causes and risk factors include:

• Gluteal tendinopathy: Degeneration or tears in the gluteus medius or minimus tendons

• Bursitis: Inflammation of the trochanteric bursa due to repetitive friction or trauma

• Iliotibial band syndrome: Tightness and rubbing of the IT band over the greater trochanter

• Overuse or repetitive stress: Common in runners or individuals with physically demanding activities

• Pelvic or hip biomechanical abnormalities: Including leg length discrepancies or altered gait

• Obesity and age-related degeneration

• Previous hip surgery or trauma

Symptoms

The hallmark symptom of GTPS is pain over the outer side of the hip, which may worsen with activity or pressure. Common symptoms include:

• Pain or tenderness over the greater trochanter

• Worsening pain when lying on the affected side

• Pain during activities such as walking, climbing stairs, or standing for long periods

• Referred pain down the outer thigh

• Stiffness or weakness in the hip area

Symptoms often develop gradually and can become chronic without treatment.

Diagnosis

Diagnosis of GTPS is primarily clinical and based on patient history and physical examination. Common diagnostic steps include:

• Physical exam: Palpation of the greater trochanter reproduces pain; special tests (e.g., Trendelenburg test) may indicate gluteal muscle weakness

• Patient history: Assessment of activity levels, occupation, gait, and previous injuries

• Imaging studies:

  • Ultrasound: Can detect bursitis or tendon abnormalities

  • MRI: Useful for visualizing soft tissue structures and ruling out other causes like hip joint pathology

  • X-rays: May be used to exclude hip arthritis or fractures

Treatment

Treatment for GTPS focuses on reducing pain, improving function, and addressing underlying biomechanical issues. Management strategies include:

Conservative Treatment:

• Rest and activity modification: Avoiding activities that worsen symptoms

• Physical therapy: Stretching, strengthening exercises (especially for gluteal muscles), and gait retraining

• Ice or heat therapy: To relieve pain and inflammation

• Nonsteroidal anti-inflammatory drugs (NSAIDs): For pain relief

Interventional Treatments:

• Corticosteroid injections: Into the bursa or tendon sheath for inflammation control

• Platelet-rich plasma (PRP) injections: In refractory cases for tendon healing

• Extracorporeal shockwave therapy (ESWT): May be beneficial in chronic tendinopathy

Surgical Intervention:

• Reserved for severe or persistent cases that do not respond to conservative treatment

• Procedures may include bursectomy or gluteal tendon repair

Prognosis

The prognosis for GTPS is generally good with appropriate conservative management. Most individuals experience significant symptom relief within weeks to months of treatment. Chronic or recurrent cases may require more intensive therapies or procedural intervention. Addressing contributing factors such as muscle weakness, poor posture, and overuse is key to long-term recovery and preventing recurrence. Early diagnosis and intervention can significantly improve outcomes and reduce the risk of chronic disability.