GREATER TROCHANTERIC PAIN SYNDROME
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Lateral hip pain, in the region of the greater trochanter, is commonly greater trochanteric pain syndrome (GTPS). The condition may also be referred to as “trochanteric bursitis” or “gluteal tendinopathy”.
Pain originates in the gluteus medius and minimus tendons. It was previously thought the primary source of pain was inflammation of the trochanteric bursa, and thus called “bursitis", however it has more recently been shown that true bursitis is rarely present.
Risk factors for developing greater trochanteric pain syndrome include older age, reduced oestrogen levels, and excessive or sudden changes in load.
GTPS is seen in both men and women across the lifespan, although women are more likely to suffer from GTPS due to biomechanical forces of having a wider pelvis and greater body adiposity. Post-menopausal women are most burdened by the condition due to hormonal changes.
Greater trochanteric pain syndrome is a clinical diagnosis and imaging is not required.
History commonly includes a change in load (eg, starting a walking program or new exercise routine) and pain in positions where the tendons may be compressed (eg, sitting with legs crossed and lying on (either) side). Other common reports include pain with sit-to-stand, after a period of sitting, and walking up and down stairs or slopes.
The most sensitive objective measure is palpation over and around the greater trochanter.
TREATMENT OPTIONS
Corticosteroid injection (CSI) can have an adverse effect on tendon health and is not recommended. Benefits of CSI are short-term only, with high rates of recurrence.
Platelet-rich plasma (PRP) injection is better than CSI, but no better than placebo injection.
Strength based exercise prescribed in conjunction with education about avoiding gluteal tendon compression, and advice regarding load management, provides the most benefit.
Education involves instruction to avoid positions of hip adduction, including:
Avoid sitting in a position with legs crossed.
Stand evenly on both feet and hip width apart.
Avoid lying on either side, but if side lying is the only option, then place a pillow between the legs to avoid the top leg falling into a position of adduction.
Avoid stairs in the short term.
Gluteal stretching is not recommended and will delay recovery due to compression of the gluteal tendons.
Isometric loading has been advocated over dynamic strengthening.
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