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GREATER TROCHANTERIC PAIN SYNDROME
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Background

Greater trochanteric pain syndrome (GTPS) is a regional pain disorder in which patients experience lateral hip pain and tenderness. These symptoms may be caused by inflamed tendons, muscles, bursa or other structures surrounding the greater trochanter, the large bony prominence on the side of the hip.

 

GTPS is one of the most common causes of lateral hip pain in adults and affects women more than men. One study in adults aged 50-75 found that 15 percent of women and 6.6 percent of men were affected.

In the past, this condition was called “trochanteric bursitis,” as it was generally accepted that pain on the side of the hip was caused by inflammation of the trochanteric bursa. Recent ultrasound and MRI studies suggest that lateral hip pain is more often caused by inflammation in other parts of the hip, such as the gluteal muscle tendons (gluteus maxiumus, medius, and minimus), the head of the femur bone or other soft tissue structures.

 

Symptoms

Symptoms of Greater Trochanteric Pain Syndrome may include lateral hip pain, swelling or stiffness. These symptoms can get worse with walking and by applying pressure to the affected side. Many patients complain of difficulty sleeping on the affected side at night due to pain. Pain may occur on one or both sides and is often felt directly over or around the greater trochanter.

 

Risk factors for the development of GTPS include female gender, obesity, knee pain, iliotibial band tenderness and low back pain. GTPS does not typically cause redness, extreme swelling, fever or malaise. These symptoms may indicate you are developing an infection or other another condition.

 

Sports Medicine Evaluation & Treatment

To evaluate GTPS, your sports medicine physician will obtain a thorough history of your symptoms and conduct a specialized physical exam. It is generally not necessary to obtain x-rays or other imaging. However, your provider may order an x-ray, inoffice ultrasound or in rare cases, a CT or MRI scan if they have other concerns.

 

Most cases of Greater Trochanteric Pain Syndrome resolve on their own within several weeks or months, but sometimes symptoms may persist up to one or two years. For treatment, your provider may recommend modified activity patterns, cold or heat therapy, NSAIDS (like ibuprofen) or other oral analgesics, home exercise program and/or formal physical therapy.

 

Glucocorticoid steroid injections may be considered after conservative treatments fail, or the patient is in too much pain to complete rehabilitation exercises. In very rare or refractory cases, surgery may be indicated.

 

Injury Prevention

The best treatment is prevention! Stretching and strengthening exercises for the IT band, quadriceps, hamstrings, gluteal musculature and low back will keep you limber, strong and painfree

 

Eating a healthy diet consisting of fruits, vegetables, and healthy sources of protein and fats also reduces inflammation and can help you maintain a healthy weight. Avoid tobacco products, drugs, and excessive caffeine and try to get plenty of sleep. If you sit at a desk job, break up your day with periodic movement and stretching.

 

Return to Play

For the general population, you do not need to avoid physical activity or sports if you have symptoms of GTPS. You may need to modify your activity, however, until the symptoms have decreased to a manageable level.

 

For athletes, GTPS does not always mean sitting out. Your sports medicine physician will work along with your coaches, trainers and other support staff to determine if and when you may return to play.

AMSSM Member Authors
Ari Levine, MD and Jacklyn Kiefer, DO

References
1. Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. 2007;88(8):988-92.
2. Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001;44(9):2138-45.
3. Fearon AM, Scarvell JM, Neeman T, Cook JL, Cormick W, Smith PN. Greater trochanteric pain syndrome: defining the clinical syndrome. Br J Sports Med. 2013;47(10):649-53.

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