What are the management options for Greater Trochanteric Pain Syndrome (GTPS)?

From the Guidelines

Management of Greater Trochanteric Pain Syndrome (GTPS) should prioritize conservative approaches, including rest, activity modification, and physical therapy, with first-line treatments focusing on NSAIDs and corticosteroid injections for persistent cases. The goal of treatment is to reduce inflammation and pain, and improve quality of life, with a focus on minimizing morbidity and mortality. According to recent evidence, US can detect trochanteric bursitis 1, and differentiation between bursitis and gluteus medius tendinosis may be difficult, as the two may coexist 1. Some key management options for GTPS include:

• NSAIDs such as ibuprofen or naproxen for 1-2 weeks to reduce inflammation and pain
• Physical therapy focusing on hip abductor strengthening, iliotibial band stretching, and core stabilization exercises for 6-8 weeks
• Corticosteroid injections into the greater trochanteric bursa for persistent cases, which can provide relief for 3-6 months
• Avoiding activities that exacerbate symptoms, such as prolonged sitting, climbing stairs, or running on uneven surfaces
• Considering extracorporeal shock wave therapy for refractory cases, and reserving surgical intervention for cases that fail 6-12 months of conservative management. The use of US to guide injections, as suggested by Douis et al 1, can improve the accuracy of corticosteroid injections, and Robbins et al 1 suggest that the bursa may be injected with either lidocaine alone, highlighting the importance of individualized treatment approaches. Overall, a comprehensive treatment plan that addresses the underlying causes of GTPS, including inflammation and biomechanical factors, is essential for effective management and improving patient outcomes.

From the Research

Management Options for Greater Trochanteric Pain Syndrome (GTPS)

The management of GTPS can be divided into conservative and surgical options.

• Conservative management includes:
  • Physical therapy 2, 3, 4, 5
  • Non-steroidal anti-inflammatory drugs (NSAIDs) 3, 4
  • Corticosteroid injections 3, 4
  • Weight loss and behavior modification 4
  • Repetitive low-energy radial shock wave therapy and home training approach 2
• Surgical management is typically indicated in patients with chronic symptoms refractory to conservative therapy 3, 6, 5
  • Open and endoscopic surgical options are available 3, 5
  • Surgical techniques should be guided by the specific etiology of pain 3

Effectiveness of Management Options

• Significant pain relief and improved outcomes have been observed after conservative and surgical management of GTPS 2
• Repetitive low-energy radial shock wave therapy and home training approach have been shown to provide beneficial effects over months, with almost 80% success rate at 15 months 2
• The effectiveness of various treatment modalities needs to be tested in carefully conducted randomized controlled trials 2

Diagnosis and Treatment

• GTPS is primarily a clinical diagnosis, and careful clinical examination is essential for accurate diagnosis and treatment 3
• A thorough history and physical exam may be used to help differentiate GTPS from other common causes of hip pain 3
• Plain radiographs and magnetic resonance imaging may be useful to exclude alternative pathologies or guide treatment of GTPS 3