Is trochanteric pain syndrome caused by lumbar degenerative disc disease?

From the Guidelines

Trochanteric pain syndrome is not directly caused by lumbar degenerative disc disease, although the two conditions can coexist and sometimes influence each other. Trochanteric pain syndrome primarily involves pain and tenderness over the greater trochanter of the femur, typically resulting from inflammation or irritation of the bursa (trochanteric bursitis) or tendinopathy of the gluteal muscles that attach near this area. The main causes include repetitive microtrauma, muscle imbalances, altered biomechanics, and direct injury 1. While lumbar degenerative disc disease affects the spine and can cause back pain and radicular symptoms, it doesn't directly cause trochanteric pain syndrome. However, altered gait patterns or posture compensations due to back pain from disc disease may secondarily contribute to hip mechanics that increase stress on the trochanteric region.

Key Points to Consider

• Trochanteric pain syndrome is a condition that affects the hip, specifically the area around the greater trochanter of the femur.
• The primary causes of trochanteric pain syndrome include inflammation or irritation of the bursa, tendinopathy of the gluteal muscles, repetitive microtrauma, muscle imbalances, and altered biomechanics.
• Lumbar degenerative disc disease is a condition that affects the spine and can cause back pain and radicular symptoms, but it does not directly cause trochanteric pain syndrome.
• Treatment for trochanteric pain syndrome typically includes physical therapy, activity modification, anti-inflammatory medications, and sometimes corticosteroid injections 1.

Diagnostic Considerations

• Imaging studies such as MRI and US can be used to diagnose trochanteric pain syndrome and rule out other conditions that may be causing the pain.
• MRI is highly sensitive and specific for detecting many abnormalities involving the surrounding soft tissues and should be the first imaging technique used after radiographs 1.
• US can be used to detect trochanteric bursitis and other findings seen with trochanteric pain syndrome, and can also be used to guide injections for diagnostic and therapeutic purposes 1.

Treatment Considerations

• Treatment for trochanteric pain syndrome should focus on addressing the underlying causes of the condition, such as inflammation or tendinopathy.
• Physical therapy, including hip abductor strengthening and stretching tight structures like the iliotibial band, can be an effective treatment for trochanteric pain syndrome.
• Activity modification, anti-inflammatory medications, and sometimes corticosteroid injections may also be necessary to manage symptoms and promote healing.

From the Research

Association between Trochanteric Pain Syndrome and Lumbar Degenerative Disc Disease

• Trochanteric pain syndrome has been found to be associated with lumbar degenerative disc disease, with studies suggesting that it can complicate differential diagnosis and accompany lumbar pain 2, 3.
• A retro-prospective analysis of 172 patients with lumbar spine degenerative diseases found that 79.5% of patients had increased pain in the hip early post-operatively, highlighting the need for awareness among physicians of the association between the two conditions 2.
• Another study found that patients with chronic low back pain and sciatica may also have greater trochanteric bursitis pain syndrome, which can mimic nerve root pressure syndrome and simulate major hip diseases 3.

Diagnosis and Treatment of Trochanteric Pain Syndrome

• Trochanteric pain syndrome is primarily a clinical diagnosis, and careful clinical examination is essential for accurate diagnosis and treatment 4.
• Conservative management, including physical therapy, non-steroidal anti-inflammatory drugs, and corticosteroid injections, is often effective in treating trochanteric pain syndrome, while operative management may be indicated in patients with chronic symptoms refractory to conservative therapy 4, 5.
• Local injection of the tender peritrochanteric area has been found to be effective in relieving symptoms of trochanteric pain syndrome, with one study finding that patients who received an injection had a better clinical outcome than those who did not 3.

Relationship between Trochanteric Pain Syndrome and Other Conditions

• Trochanteric pain syndrome has been found to be related to lumbar degenerative disease, hip osteoarthritis, knee osteoarthritis, and failed back surgery syndrome, highlighting the importance of accurate diagnosis and treatment of the condition 6.
• Gluteus medius syndrome, which is similar to trochanteric pain syndrome, has also been found to be associated with lumbar degenerative disease and hip osteoarthritis, and accurate diagnosis and treatment of the condition may improve outcomes for patients with these conditions 6.