Greater Trochanteric Pain Syndrome / Trochanteric Bursitis

Greater Trochanteric Pain Syndrome / Trochanteric Bursitis

Anatomy

The greater trochanter of the femur is the area of your lateral hip where you can feel your bone. This proximal portion of the femur is where two hip abductor tendons attach (gluteus medius and gluteus minimus), which lie underneath the iliotibial (IT) band.

The gluteus medius muscle attaches at the superior lateral portion of the iliac crest of the pelvis and lies superficially over the gluteus minimus, and underneath portions of the gluteus maximus (posteriorly) and Tensor Fascia Lata (anteriorly). The IT band is a tendon where the gluteus maximus and tensor fascia muscles meet in the proximal lateral leg.

The gluteus minimus muscle attaches at the external surface of the ilium, lying inferior to the gluteus medius muscle. The distal attachment is located at the anterior facet of the greater trochanter.

The gluteus medius and minimus helps with our normal activities of walking, running, standing, and climbing stairs.

Etiology

Greater trochanteric pain syndrome encompasses several causes of pain at the lateral aspect of the hip. This may include greater trochanteric bursitis, iliotibial band tendinitis as well as gluteal tendinopathies.

Greater trochanteric pain syndrome can occur for several reasons:

  • Degenerative tearing

  • Hip and core musculature weakness

  • IT band friction from a thickened or contracted IT band.

  • Acute Trauma – Falls, blunt trauma

  • Overuse or disuse

  • Underlying hip pathology or morphology (shape)

    • Hip dysplasia

    • Hip impingement (at the hip joint or outside of hip joint)

Greater trochanteric pain syndrome is also commonly mistaken for sciatic nerve pain or osteoarthritis.

Diagnosis

Greater trochanteric pain syndrome is diagnosed using a full history and physical examination which likely includes testing such as X-rays. This helps to develop a comprehensive determination as to the cause of lateral hip pain.

Typically, there is tenderness on examination with direct palpation over the greater trochanter of the hip. This may coexist with other positive findings in the physical examination including hip abductor weakness, muscle contracture, or positive impingement testing.

Greater trochanteric pain syndrome can affect anywhere from 10-25% of the population in industrialized nations. Risk factors for greater trochanteric pain syndrome include gender, as this is much more common in women than men (3-4 female:1 male ), increased body mass index ( BMI over 30) as well as prior episodes of hip or low back injury or disease. Chronic disuse may also lead to chronic pain at the lateral hip area.

Treatment

Greater trochanteric pain syndrome is generally treated successfully with non-operative care.

Conservative Care Options:

  • Oral or topical medications – Non-steroidal anti-inflammatory medications

  • Activity modifications

  • Physical therapy

  • Through multiple methods of addressing the body’s current condition, physical therapy can strengthen the surrounding musculature, stretch excessively tight soft tissues, and also optimize the healing environment for the injured tissue.

  • Injections

    • Steroid injections may offer temporary relief of pain in an effort to improve conditioning of the hip’s supporting musculature and soft tissues.

    • Biologics injections

      • PRP (platelet rich plasma) or

      • BMAC (Bone Marrow Aspirate Concentrate) is also an option that allows for the body’s natural healing cells to provide pain relief and optimize a healing environment.

Likely, a combination of these methods will produce resolution of symptoms along with improvement towards normal function.

Surgery

Surgical Care options may be necessary to treat underlying or contributing orthopedic conditions:

  • Endoscopic surgery

    • Utilizing arthroscopic techniques, the greater trochanter pain generators may be addressed with bursectomy, tendon repair or IT band release.

    • Open surgery

    • Addressing the contributing factors leading to greater trochanteric pain syndrome

    • Hip arthroscopy to correct femoroacteabular impingement

    • Total hip arthroplasty

    • Periacetabular osteotomy for hip dysplasia

These techniques may be combined with other hip procedures in the same setting depending on other conditions that may need to be treated in the same setting.

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Sources:

Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment.

Greater trochanter bursitis pain syndrome in females with chronic low back pain and sciatica.

The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review.

Long-term outcome of low-energy extracorporeal shockwave therapy on gluteal tendinopathy documented by magnetic resonance imaging.

Does low back pain or leg pain in gluteus medius syndrome contribute to lumbar degenerative disease and hip osteoarthritis and vice versa? A literature review.

Iliotibial band Z-lengthening for refractory trochanteric bursitis (greater trochanteric pain syndrome).

Hip Stability May Influence the Development of Greater Trochanteric Pain Syndrome: A Case-Control Study of Consecutive Patients.

Greater trochanteric pain syndrome.

Ultrasound-guided Platelet-rich Plasma Application Versus Corticosteroid Injections for the Treatment of Greater Trochanteric Pain Syndrome: A Prospective Controlled Randomized Comparative Clinical Study.