What is trochanteric pain syndrome?

Greater Trochanteric Pain Syndrome (GTPS)

Greater Trochanteric Pain Syndrome (GTPS) is a clinical condition characterized by chronic, intermittent aching pain over the lateral aspect of the hip, encompassing a spectrum of disorders including trochanteric bursitis, abductor tendon pathology, and external coxa saltans. 1, 2

Clinical Presentation

• GTPS presents with persistent pain in the lateral hip that may radiate along the lateral thigh to the knee and occasionally below the knee or to the buttock 3
• Physical examination reveals point tenderness in the posterolateral area of the greater trochanter 3
• The condition peaks between the fourth and sixth decades of life but can occur in all age groups 4
• GTPS has a higher prevalence in women and patients with coexisting low back pain, osteoarthritis, iliotibial band tenderness, and obesity 3

Diagnostic Approach

• Radiographs should be obtained first to rule out other causes of hip pain such as arthritis or bone tumors 5, 6
• Ultrasound can effectively detect trochanteric bursitis but may have difficulty distinguishing it from gluteus medius tendinosis, which often coexists 7, 6
• MRI is appropriate after negative or indeterminate radiographs and can assess peritrochanteric structures including the gluteus minimus and medius muscles, abductor tendons, and the trochanteric bursa 5, 6
• Diagnostic injections can confirm the location of pain and provide temporary relief 5

Management Algorithm

First-Line Treatment

• Physical therapy with targeted exercises for hip abductor muscles shows superior long-term outcomes compared to other interventions 6, 2
• Activity modification to decrease repetitive loading of the damaged tendon and bursa 7, 6
• NSAIDs for pain relief and anti-inflammatory effects 7, 6
• Acetaminophen for mild to moderate pain (not exceeding 4 grams daily) 6

Second-Line Treatment

• Corticosteroid injection into the trochanteric bursa provides both diagnostic information and therapeutic benefit 5, 7
• Ultrasound guidance improves the accuracy of corticosteroid injections 7, 6
• Extracorporeal shock wave therapy (ESWT) has shown promising results with 68.3% improvement in pain scores compared to control groups 2

Third-Line Treatment

• Surgical intervention should only be considered after failure of 3-6 months of comprehensive conservative treatment 7, 6
• Various surgical options, both open and endoscopic, are available and should be guided by the specific etiology of pain 1
• The complication and re-intervention rate for surgical management should not be underestimated 8

Important Clinical Considerations

• Differentiation between trochanteric bursitis and gluteus medius/minimus tendinosis can be difficult, and the two conditions frequently coexist 7, 6
• In patients with hip prostheses, extracapsular disease associated with adverse reactions to metal debris could be misinterpreted as trochanteric bursitis 5, 6
• Combining physical therapy with corticosteroid injections appears more effective in managing acute symptoms than physical therapy alone 2
• The evidence supporting platelet-rich plasma (PRP) remains inconclusive, with ongoing research needed to clarify its role 2

Treatment Efficacy

• Physical therapy has shown symptom resolution in 60.5% of patients at 15 months 2
• Corticosteroid injections provide pain reduction in the first months, but this effect does not persist long-term 8
• Most cases of GTPS are self-limited with conservative measures such as physical therapy, weight loss, NSAIDs, and behavior modification 3