What are the risk factors for Trochanteric Pain Syndrome (TPS)?

Risk Factors for Trochanteric Pain Syndrome

Female sex, obesity, knee osteoarthritis, and low back pain are the most significant risk factors for developing Trochanteric Pain Syndrome. 1

Primary Risk Factors

Demographic Factors

• Sex: Women have 3.37 times higher risk than men, with prevalence of 23.5% in women versus 8.5% in men 1
• Age: Peak incidence occurs between fourth and sixth decades of life 2, though the condition can affect all age groups

Anatomical and Biomechanical Factors

• Altered lower limb biomechanics 1:
  • Iliotibial band tenderness (OR=1.72)
  • Ipsilateral knee osteoarthritis (OR=3.47)
  • Contralateral knee osteoarthritis (OR=1.74)
• Low back pain (OR=2.79) 1
• Repetitive frictional trauma to gluteal tendons and associated bursae from impingement beneath the tensor fascia lata 3

Secondary Risk Factors

Physical Factors

• Obesity: While the direct association with BMI showed mixed results in multivariate analysis 1, clinical guidelines recognize obesity as a factor requiring special consideration during treatment 4
• Gluteal muscle weakness, particularly of hip abductors 4
• Acute local direct trauma or hyperadductive strain injury 3

Functional Impairments

• Bilateral TPS is associated with:
  • Slower 20-meter walk time
  • Increased chair stand time 1
  • Reduced mobility

Clinical Implications

Diagnostic Considerations

• Risk factors should guide clinical suspicion, especially in women with concurrent knee OA or low back pain
• The American College of Radiology recommends:
  • Radiographs as first-line imaging 4
  • Ultrasound for detecting associated bursitis and tendinopathy 4
  • MRI as the best modality for assessing peritrochanteric structures 4

Treatment Planning

• Higher-risk patients (female, with knee OA or low back pain) may benefit from earlier intervention
• Treatment should address biomechanical factors:
  • Eccentric strengthening exercises for hip abductors 4
  • Deep transverse friction massage 4
  • Corticosteroid injections (40-80 mg methylprednisolone with 2-3 mL of 1-2% lidocaine) 4

Common Pitfalls and Caveats

• Misdiagnosis: TPS is often misdiagnosed as simple trochanteric bursitis, when gluteal tendinopathy may be the primary pathology 5, 6
• Incomplete evaluation: Failure to assess for associated conditions (knee OA, low back pain) may lead to inadequate treatment
• Overlooking biomechanical factors: Treatment focused solely on pain management without addressing underlying biomechanical issues often leads to recurrence
• Differential diagnosis challenges: Distinguishing between trochanteric bursitis and gluteus medius tendinosis can be difficult as they frequently coexist 4

Understanding these risk factors allows for targeted prevention strategies and more effective management approaches for patients with Trochanteric Pain Syndrome.