Can greater trochanter pain syndrome and same-side lumbar sacral pain be associated without a primary cause of the back pain?

Greater Trochanteric Pain Syndrome and Lumbar-Sacral Pain Association

Greater trochanteric pain syndrome (GTPS) and same-side lumbar-sacral pain can be associated without a primary cause of back pain, as GTPS is frequently found in patients with low back pain and may mimic or coexist with spinal pathology. 1, 2

Epidemiology and Clinical Significance

• GTPS has a prevalence of 20.2% among patients referred to orthopedic spine specialists for low back pain evaluation, with a significantly higher prevalence in women 2
• GTPS is often misdiagnosed, with 54.9% of patients having already undergone MRI examinations and 62.7% having been evaluated by orthopedic or neurosurgical specialists before correct diagnosis 2
• The syndrome is commonly found in different clinical settings, with prevalence rates of 25% in general practice, 18% in occupational health services, and 45% in rheumatology outpatient clinics among patients with low back pain 3

Pathophysiology and Clinical Relationship

• GTPS can mimic symptoms of lumbar nerve root compression, creating diagnostic confusion with spinal pathology 2
• The condition is characterized by pain and reproducible tenderness in the region of the greater trochanter, buttock, or lateral thigh 2
• MRI can be used to assess peritrochanteric structures including the gluteus minimus and medius muscles, abductor tendons, and the trochanteric bursa in patients with hip and back pain 4
• Differentiation between bursitis and gluteus medius tendinosis may be difficult on imaging, and the two conditions may coexist 4

Diagnostic Considerations

• Radiographs are usually the first imaging modality for assessment of hip pain, but they have limited sensitivity for soft tissue pathology 4
• MRI is the preferred imaging modality for evaluating soft tissue abnormalities around the hip when radiographs are negative or nondiagnostic 4
• Ultrasound can detect trochanteric bursitis and can guide diagnostic or therapeutic injections 4
• Diagnostic injection with lidocaine alone or in combination with corticosteroids can help confirm GTPS as the source of pain 4

Clinical Implications

• Ignoring GTPS symptoms in patients with lumbar spine complaints can lead to unnecessary diagnostic tests, specialty referrals, and potentially unwarranted surgery 2
• In a study of patients with lumbar degenerative disc disease and GTPS, 79.5% had increased hip pain early postoperatively, requiring trigger point injections 1
• Some patients with presumed spinal pathology may experience complete pain resolution after GTPS treatment, avoiding unnecessary spine surgery 1
• Clinical features associated with GTPS include radiating pain and paresthesias in the legs, tenderness of the ilio-tibial tract, and pain aggravation during standing, descending stairs, lying on the affected side, and crossing legs 3

Management Approach

• Local injection of the tender peritrochanteric area with corticosteroids and anesthetic provides significant clinical improvement in patients with concurrent low back pain and GTPS 5
• Patients with chronic low back pain and sciatica should be routinely checked for GTPS, as it is easy to diagnose and can be effectively treated 5
• Endoscopic treatment has shown good to excellent results for GTPS cases that fail conservative management 6
• Timely detection of GTPS in patients being evaluated for spinal pathology can significantly influence treatment tactics and may prevent unnecessary surgical interventions 1

Clinical Pitfalls to Avoid

• Failing to consider GTPS in the differential diagnosis of patients with low back pain, especially in middle-aged women 2
• Attributing all symptoms to spinal pathology without examining for peritrochanteric tenderness 5
• Proceeding with spine surgery without addressing coexisting GTPS, which may lead to persistent or worsened pain postoperatively 1
• Relying solely on advanced imaging without performing a thorough physical examination that includes assessment of the greater trochanteric region 2