Can pain associated with soft tissue clicking over the greater trochanter be debilitating?

Pain Associated with Soft Tissue Clicking Over the Greater Trochanter Can Be Debilitating

Yes, pain associated with soft tissue clicking over the greater trochanter can be severely debilitating, significantly affecting quality of life and function in affected individuals. 1

Understanding Greater Trochanteric Pain Syndrome (GTPS)

Greater trochanteric pain syndrome is characterized by pain at or around the greater trochanter, which can manifest with clicking sensations and can significantly impact daily activities:

• GTPS is often a debilitating condition causing lateral hip pain that can severely limit function and quality of life 1, 2
• Patients with GTPS report high levels of pain (average visual analog score of 6.5) and low health-related quality of life scores 2
• The condition can persist for extended periods, with over 56% of patients experiencing symptoms for 12 months or longer 2

Clinical Presentation and Diagnosis

• Radiographs should be obtained first in most cases to rule out other causes of hip pain, such as arthritis or bone tumors 3
• Soft tissue clicking over the greater trochanter is often associated with:
  • Abductor tendon abnormalities 3
  • Trochanteric bursitis 4
  • Gluteus medius/minimus tendinosis, which frequently coexists with bursitis 4, 5
• Ultrasound can effectively detect trochanteric bursitis and evaluate gluteal tendons in patients with persistent symptoms 4, 6
• MRI can provide comprehensive assessment of peritrochanteric structures including the gluteus minimus and medius muscles, abductor tendons, and the trochanteric bursa 4

Impact on Quality of Life

• Patients with GTPS often experience significant functional limitations that affect daily activities 2
• The condition is associated with high medication use (82.7% of patients) and frequently coexists with other medical conditions (79% of patients) 2
• The debilitating nature of the condition is reflected in poor outcomes on standardized measures of health-related quality of life 2

Treatment Options

• First-line conservative treatments include:
  • NSAIDs for pain relief and anti-inflammatory effects 4
  • Physical therapy, including stretching exercises for the iliotibial band and strengthening of hip abductor muscles 4
  • Activity modification to reduce pressure on the affected area 4
• Corticosteroid injection into the trochanteric bursa can provide both diagnostic information and therapeutic benefit, though the pain relief effect may not persist long-term 4, 7
• Ultrasound guidance improves the accuracy of corticosteroid injections 4
• Low energy shock wave therapy may provide positive effects in the short term, though long-term results are more controversial 7
• Surgical intervention should only be considered after failure of 3-6 months of comprehensive conservative treatment 4

Common Pitfalls and Caveats

• Differentiation between trochanteric bursitis and gluteus medius tendinosis can be difficult, and the two conditions may coexist 4
• In patients with hip prostheses, extracapsular disease associated with adverse reactions to metal debris could be misinterpreted as trochanteric bursitis 4
• Surgical treatment should be reserved only for cases failing to respond to conservative measures, as complication and re-intervention rates should not be underestimated 7

Special Considerations

• Radiographs showing >2 mm surface irregularities of the greater trochanter have been associated with abductor tendon abnormalities and peritendinous edema on MRI, though these findings have limited specificity 3
• Histopathologic findings show that tendinopathy and bursa pathology often coexist in greater trochanteric pain syndrome 6