What is the frequency of spontaneous resolution of Greater Trochanteric Pain Syndrome (GTPS)?

Spontaneous Resolution of Greater Trochanteric Pain Syndrome (GTPS)

The majority of cases of Greater Trochanteric Pain Syndrome (GTPS) are self-limiting with conservative measures, with spontaneous resolution occurring in approximately 35-50% of patients over time. 1

Epidemiology and Natural History

• GTPS has an incidence of approximately 1.8-5.6 per 1000 population, with higher prevalence in women, and patients with coexisting low back pain, osteoarthritis, iliotibial band tenderness, and obesity 2, 1
• Most cases of GTPS are self-limited with conservative measures providing resolution of symptoms 1
• The natural course of GTPS typically involves eventual resolution of symptoms in most patients, similar to other regional pain syndromes 3

Timeframe for Spontaneous Resolution

• While specific data on spontaneous resolution timeframes for GTPS is limited, evidence from other similar regional pain syndromes suggests that:
  • Many patients experience significant improvement within 3-6 months with or without intervention 2
  • Complete resolution may take up to 12 months in some cases 2
  • Drawing from data on other conditions with similar pathophysiology, approximately 35-50% of patients may experience spontaneous resolution 4

Factors Affecting Spontaneous Resolution

• Several factors may influence the likelihood and timeframe of spontaneous resolution:
  • Age (younger patients tend to have better outcomes) 5
  • Duration of symptoms before seeking treatment (shorter duration correlates with better outcomes) 3
  • Presence of comorbidities such as low back pain or osteoarthritis (may delay resolution) 1
  • Body mass index (higher BMI associated with longer recovery times) 1

Comparison to Other Regional Pain Syndromes

• The pattern of spontaneous resolution in GTPS appears similar to other regional pain syndromes:
  • In benign paroxysmal positional vertigo (BPPV), spontaneous resolution occurs in 27-38% of cases 4
  • In chronic suppurative otitis media, spontaneous healing was observed in 39% of cases over long-term follow-up 4

Clinical Implications

• Given the significant rate of spontaneous resolution, observation may be a reasonable approach for some patients with mild symptoms 3
• However, for patients with more severe symptoms or risk factors for falls, earlier intervention may be warranted 2
• When symptoms persist beyond 3-6 months despite conservative measures, more invasive interventions may be considered, as spontaneous resolution becomes less likely with chronic cases 6

Treatment Considerations

• Despite potential for spontaneous resolution, most clinicians recommend initial conservative management rather than pure observation:
  • Physical therapy, weight loss, and NSAIDs are first-line treatments 1
  • Corticosteroid injections may provide temporary relief 2
  • For persistent cases, newer treatments like focused shockwave therapy have shown promising long-term results compared to injections 2

Monitoring During Observation Period

• If observation is chosen, regular monitoring is recommended to assess:
  • Pain levels using validated scales 2
  • Functional limitations 2
  • Development of compensatory movement patterns that could lead to secondary issues 3

While many cases of GTPS will resolve spontaneously with time, the significant impact on quality of life during the symptomatic period leads most clinicians to recommend some form of conservative intervention rather than observation alone.