Greater Trochanteric Pain Syndrome

What is greater trochanteric pain syndrome?

Greater trochanteric pain syndrome, also called trochanteric bursitis or GTPS, is an inflammation of the bursa of the greater trochanter. Bursae are the small "cushions" between tendons, bones, and muscles. The greater trochanter is the larger of two bony knobs at the top of the thigh bone. Overuse, trauma, or infection can cause inflamed and irritated bursae around the greater trochanter.

Symptoms include chronic, persistent pain on the outside of the hip that radiates down the outside of the leg, sometimes to the knee.

Treatment largely involves managing the symptoms through weight loss, physical therapy, and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). In some cases, corticosteroid injections into the hip work well to relieve pain, and surgery can sometimes help.

You should visit your primary care physician if your pain interferes with your normal day-to-day activities or you are not finding relief. However, most cases improve without any treatment over a few weeks.

Greater trochanteric pain syndrome symptoms

Symptoms of greater trochanteric pain syndrome can be categorized by main symptoms and others that affect some people with this condition. The diagnosis is made through physical examination and observation of simple movements.

Main symptoms

The most common symptom in greater trochanteric pain syndrome is pain on the side of the hip. This pain can be described by the following details:

• Location: The pain is usually located near an outward bulge of the thigh bone located right below the level of the hip called the greater trochanter.
• Worsens with activity: The pain may get worse with walking, prolonged standing, climbing stairs, or lying on that side of the hip.
• Painful when pushed on

Other symptoms

Other symptoms that may affect some people with greater trochanteric pain syndrome include:

• Abnormal walking gait: When people walk and step onto the side with the hip pain, the opposite side of the hip may drop, causing a waddling type of gait also known as a Trendelenburg gait.
• Fatigue: Feeling more tired than usual can occur if the pain interferes with sleep, which may further exacerbate the hip pain.

Causes of greater trochanteric pain syndrome

Greater trochanteric pain syndrome involves pain in the side of the hip, thought to be due to overuse and inflammation of the muscles, tendons, and other structures in the side of the hip. Two muscles in the side of the hip, the gluteus medius and the gluteus minimus, are involved in lifting the leg sideways and stabilizing the hip. Most people who have greater trochanteric pain syndrome have damage or inflammation of these two muscles and their attachments to the thigh bone. Specific causes of greater trochanteric pain syndrome include repeated use or overuse of the hip muscles, injury, a disease of the hip joint, and infection or inflammation of the bursae.

Repeated use or overuse of the hip muscles

The most common cause of greater trochanteric pain syndrome is repeated use or overuse of the hip muscles. This can occur with frequent walking or running, suddenly increasing the amount of exercise, or standing on one leg for a long time. Overuse can cause inflammation and possibly damage to the hip muscles and other nearby structures.

Injury or prolonged pressure

Some cases of greater trochanteric pain syndrome may be caused by injury or prolonged pressure to the side of the hip. For example, this can occur if someone is lying on their side for a long time without changing positions.

Disease of the hip joint

Some cases of greater trochanteric pain syndrome may develop in people who have a pre-existing disease of the hip joint. Examples of diseases that may increase the risk of developing greater trochanteric pain syndrome include osteoarthritis ("wear-and-tear" damage to the joint) and rheumatoid arthritis (an autoimmune disease). These diseases can cause inflammation of the structures in the hip joint and make the hip easily damaged with repeated use.

Infection or inflammation of the bursae near the hip joint

In rare cases, greater trochanteric pain syndrome may be caused by infection or inflammation of the bursae, or fluid-filled sacs, that are located near the hip joint. Tuberculosis or Lyme disease may infect the bursae, and gout or other forms of arthritis may inflame the bursae.

Who is most likely to be affected

Greater trochanteric pain syndrome more commonly affect:

• Females
• People who are obese
• People with unequal leg lengths
• People with other back, hip, leg, or foot pain

Treatment options and prevention

Greater trochanteric pain syndrome is a chronic condition that requires long-term treatment to reduce symptoms. In most cases, people will experience improvements in symptoms in one to two years. Treatment options include at-home remedies, treatment of underlying conditions, as well as further medical treatment through steroid injections or surgery.

At-home treatments

Certain at-home remedies may provide relief or improvement from greater trochanteric pain syndrome, such as:

• Over-the-counter pain medications: These include acetaminophen (Tylenol) or NSAIDS such as ibuprofen (Advil, Motrin), or naproxen (Aleve).
• Heat: Applying heat to the area of the hip that is painful can be repeated multiple times per day.

Exercise routines and treatment of other conditions

Sometimes pain can be alleviated by making small adjustments or adding in a brief stretching routine with advice from a medical provider. Other details include:

• Changes in sitting position and stretching and exercise routines: Neutral sitting positions that place weight on the thighs rather than the hips may help relieve pain. Stretching and strengthening exercises targeting the hip and back muscles may also help relieve symptoms. Examples of stretching exercises include cross-leg pulls, knee-chest pulls, side bends, or pelvic rotations.
• Weight loss and/or treatment of other conditions: This approach may help alleviate pain and prevent the worsening of symptoms in people with greater trochanteric pain syndrome who are overweight or obese. In people with unequal leg lengths, correction of this with an insole or heel lifts may help alleviate symptoms.

Further medical treatments

For people whose pain is not relieved by more conservative methods mentioned above, the following may be helpful.

• Steroid injections into the side of the hip: The steroid can either be injected into the hip area or directly into one of the bursae. The steroid injections may need to be repeated for symptom relief.
• Surgery to repair damaged muscles or remove inflamed bursae: Surgery can be done through an open incision in the side of the hip or using a scope. Surgical treatment options include repairing any damaged muscles or tendons, lengthening certain supportive structures in the hip, or removing any inflamed bursae.

When to seek further consultation

If you develop any symptoms of greater trochanteric pain syndrome, such as pain in the side of the hip or an abnormal walking gait, you should consider going to your physician. He or she can perform an examination and possibly order imaging tests to determine if you have greater trochanteric pain syndrome, and then offer the appropriate treatments.