From the Research
The initial treatment for Greater Trochanteric Syndrome (GTS) should focus on conservative measures, including physical therapy, non-steroidal anti-inflammatory drugs, and corticosteroid injections, as these approaches are effective in approximately 90% of cases and address the underlying causes of GTS, which typically involve inflammation of the bursa and/or tendinopathy of the gluteal muscles at their insertion on the greater trochanter.
Key Components of Initial Treatment
- Activity modification to reduce repetitive hip flexion or weight-bearing
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce pain and inflammation 1
- Physical therapy focusing on stretching and strengthening of the hip abductor muscles, particularly the gluteus medius, which is essential for recovery 1
- Ice application for 15-20 minutes several times daily to manage acute pain
- Weight loss recommended for overweight patients to reduce pressure on the affected area
Considerations for Further Treatment
If conservative measures fail to provide relief after 4-6 weeks, corticosteroid injections (typically 40mg methylprednisolone or equivalent with local anesthetic) into the trochanteric bursa may be considered 2. Operative management, including open and endoscopic options, is typically reserved for patients with chronic symptoms refractory to conservative therapy 3, 4.
Importance of Accurate Diagnosis
A thorough history and physical exam are crucial for accurate diagnosis and treatment of GTS, differentiating it from other common causes of hip pain such as osteoarthritis, femoroacetabular impingement, and lumbar stenosis 1. Imaging studies like plain radiographs and magnetic resonance imaging may be useful to exclude alternative pathologies or guide treatment 1.