Greater trochanteric pain syndrome

• Greater trochanteric pain syndrome:

  • Previously called trochanteric bursitis - renamed as discovered that the trochanteric bursae plays a smaller role than previously thought
  • Caused by irritation to tissues overlying greater trochanter (e.g. muscles, tendons, fascia or bursae) resulting in pain
  • Often co-existence of bursitis and tendinopathy
• Cause:

  • Repetitive friction between iliotibial band and greater trochanter causing irritation to surrounding structures
  • Rarely caused by infection of trochanteric bursa (septic bursitis) - patients would have warm erythematous swelling and pain over bursa and may be systemically unwell
  • Frequently seen with other conditions - OA, degenerative disc disease, radiculopathy, RA, iliotibial band syndrome
• Risk factors:

  • Female aged 40-60 (although can occur in young people especially runners, footballers and dancers)
  • High BMI
  • Sudden increase in activity/load
  • Trauma
  • Smoking - delays tissue healing
• Presentation:

  • Gradual onset lateral hip pain over greater trochanter - described as aching/burning
  • Pain may radiate down outer thigh
  • Worse with activity, standing after sitting for a long period, sitting crossed legged
  • Pain can disrupt sleep - painful lying on affected side
• Examination:

  • Tenderness over greater trochanter
  • Not usually any swelling (unlike bursitis in other areas)
  • Antalgic gait
  • Trendelenburg gait and sign - hip abductors inset into greater trochanter - tendinopathy of these can cause greater trochanteric pain syndrome
  • Lateral hip pain on resisted abduction, internal and external rotation
• Diagnosis is clinical, core clinical features are:

  • Lateral hip pain
  • Aggravated by physical activity
  • Point tenderness adjacent to greater trochanter
• Management:

  • Reassurance - usually self limiting, resolves in over 90% of people with conservative treatment but may take months
  • Conservative - relative rest, ice, analgesia, manage risk factors e.g. weight loss and smoking
  • Refer to physio if walking aids needed
  • If conservative measures fail - corticosteroid injection and referral to physio
  • Occasionally refractory cases might need surgical treatment
• Refer if:

  • Atypical symptoms
  • Red flags - infection, malignancy, inflammatory arthropathy, trauma
  • Not improving with conservative management