Greater Trochanter Pain Syndrome

Greater trochanteric pain syndrome (GTPS) is a term related to pain caused by a variety of problems at the side of the hip bone called the greater trochanter. These include damage to the tendons that support the hip and pelvis, inflammation and swelling of the bursa associated with the tendons and a rubbing pressure of a band on tendon called the illio tibial band.syndrome.

The tendons surrounding the hip can become torn or strained as similar problems appear in the shoulder. Because it is more difficult to rest and we have to move about continued stress is put on the damaged tissues.

A bursa consists of a membrane surrounding a small amount of fluid. This is situated between tendons so that when they can move freely over and around eachother. Incircumstances where muscles and tendons are being overused without adequate rest then the bursa can become inflamed and swell. Increasing in size and causing pressure on the tissues and pain receptors. Usually diagnosic ultrasound cannot visualise the bursa but when it has becaome inflamed the fluid swells sothat is it seen and measured, sometimes it can be complicated with increased vascularity.

The ilio tibial band connects the tensor facia lata muscle on the side of the hip and its tendon reaches below the knee, it gives support to the muscles and the side of the thigh. When activity increases especially with runners then the band can rub against the bony prominence of the hip called the greater trochanter. It can cause hip pain and sometimes refer down to the knee.

Diagnostic imaging can show which of the above problems may be causing the pain or to rule out other causes of hip pain.by understanding what is affecting the persona and to what degree then the best suitable treatment and advice addressed.

Greater trochanteric pain syndrome (GTPS) includes a number of disorders of the lateral peritrochanteric space of the hip such as tears of the gluteus medius and minimus, trochanteric bursitis, and external coxa saltans.

The main clinical symptoms are pain and reproducible tenderness in the region of the greater trochanter and/or the buttock or lateral thigh. Diagnosis is based on the clinical features of the disease. Diagnostic imaging should be considered to rule out other causes of hip pain or to establish the diagnosis of GTPS when in doubt.

The greater trochanter is the site of attachment for the tendons of five muscles: the gluteus medius and gluteus minimus laterally, and the piriformis, obturator externus and obturator internus medially. As in the shoulder, injury and subsequent degeneration may occur in the components of the rotator cuff of the hip, starting with tendonitis, tendinosis, and eventual tear. This process occurs more commonly in the gluteus medius than the gluteus minimus.

Furthermore, there are three bursas present around the lateral aspect of the greater trochanter, i.e., the subgluteus maximus bursa, the subgluteus medius bursa and the gluteus minimus bursa. These bursas are believed to serve as cushioning for the gluteus tendons, the iliotibial band, and the tensor fascia latae. Trochanteric bursitis mostly occurs secondary to repetitive friction between the greater trochanter and the iliotibial band with hip flexion and extension. Trochanteric bursitis is also often associated with overuse, trauma, or other conditions that may alter normal gait patterns.

GTPS has been reported to affect between 10% and 25% of the general population, with an increased prevalence in women compared to men.

Therapy of symptomatic tendon tears comprises rest, antiinflammatory medications and physiotherapy focusing on range of motion and strengthening exercises. Trochanteric bursitis is usually self-limiting and responds to rest, ice, antiinflammatory medications and physiotherapy focusing on stretching, flexibility, strengthening and gait mechanics. When symptoms persist despite these interventions, bursal injections of local anesthetics and corticosteroid can provide effective pain relief.

Radial shock wave therapy (RSWT) has been demonstrated to be efficient for recalcitrant GTPS. In case of inefficacy of RSWT, surgical intervention may be considered in cases in which other potential sources of the patient’s symptoms have been ruled out.

Rompe JD, Segal NA, Cacchio A, et al.
Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med 2009;37 1981-1990
http://www.ncbi.nlm.nih.gov/pubmed/19439758

Furia JP, Rompe JD, Maffulli N.
Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. Am J Sports Med 2009;37:1806-1813
http://www.ncbi.nlm.nih.gov/pubmed/19439756