Greater Trochanteric Pain Syndrome
What is Greater Trochanteric Pain Syndrome?
Greater trochanteric pain syndrome (GTPS) includes a number of disorders of the lateral hip such as tears of the gluteus medius and minimus, trochanteric bursitis, and external coxa saltans.
The main clinical symptoms are pain and reproducible tenderness in the region of the greater trochanter and/or the buttock or lateral thigh. The diagnosis is based on the clinical features of the disease. Diagnostic imaging such as ultrasound should be considered to rule out other causes of hip pain or to establish the diagnosis of GTPS when in doubt.
DIAGNOSIS AND TREATMENT
The greater trochanter is the site of attachment for the tendons of five muscles: the gluteus medius and gluteus minimus laterally, and the piriformis, obturator externus and obturator internus medially. As in the shoulder, injury and subsequent degeneration may occur in the components of the rotator cuff of the hip, starting with tendonitis, tendinosis, and eventual tear.
This process occurs more commonly in the gluteus medius than the gluteus minimus.Furthermore, there are three bursas present around the lateral aspect of the greater trochanter, i.e., the subgluteus maximus bursa, the subgluteus medius bursa and the gluteus minimus bursa. These bursas are believed to serve as cushioning for the gluteus tendons, the iliotibial band, and the tensor fascia latae. Trochanteric bursitis mostly occurs secondary to repetitive friction between the greater trochanter and the iliotibial band with hip flexion and extension. Trochanteric bursitis is also often associated with overuse, trauma, or other conditions that may alter normal gait patterns.
‘GTPS has been reported to affect between 10% and 25% of the general population, with an increased prevalence in women compared to men.’
Trochanteric bursitis is usually self-limiting and responds to rest, ice, anti-inflammatory medications and physiotherapy focusing on stretching, flexibility, strengthening and gait mechanics. When symptoms persist despite these interventions, bursal injections of local anaesthetics and corticosteroids can provide effective pain relief.
Shock wave therapy has been demonstrated to be efficient for recalcitrant GTPS.