Greater Trochanteric Pain Syndrome

Greater Trochanteric Pain Syndrome

The term greater trochanteric pain syndrome is now being commonly substituted for trochanteric bursitis; because the inflammatory etiology of the pain is being refuted by current research, using ultrasonographic, magnetic resonance imaging and histologic evidence.

Subjective Characteristics

• Bursitis may develop gradually or traumatically.
• Pain occurring over the side of the hip.
• Referred pain that travels down the outside.thigh and may continue down to the knee.
• Pain when sleeping on your side; especially the affected hip.
• Pain upon getting up from a deep chair or after prolonged sitting (eg. in a car).
• Pain when climbing stairs.
• Increased pain when walking, cycling, or standing for long periods of time.

Contributing / Predisposing factors:

The trochanteric bursa may be inflamed by the glutes rubbing over the bursa and causing friction against the greater trochanter.

Can occur with running, walking, or cycling (especially when the saddle is too high).

It can also occur in some people who have a scoliosis, leg length discrepancy, weak hip muscles, osteoarthritis of the hips or lumbar spine, or rheumatoid arthritis.

Trochanteric bursitis can also occur following direct trauma to the side of the hip, such as in a fall.

Physical Examination

The most classic finding is point tenderness over the greater trochanter, which reproduces the presenting symptoms.  Palpation may also reproduce pain that radiates down the lateral thigh.  Swelling of the bursa may be present, but this will be difficult to identify in many patients due to the overlying tissue.  In obese patients it may be difficult to locate the greater trochanter dirrectly, therefore consider using the iliac crest as a landmark and assessing for the trochanter approximately 8 inches (20 cm) below the iliac crest.  Also consider palpating the region while passively circumducting the hip.  Overlying skin changes of ecchymosis with abrasions may occur with recent trauma.  Lateral hip pain can often be elicited by passive external rotation of the hip without provoking such symptoms by internal rotation.  Pain can also be reproduced with flexion of the hip followed by resisted hip abduction.  Groin pain or referred knee pain provoked by passive internal rotation of the hip may indicate hip joint pathology (such as osteoarthritis).  To assess for sciatica or lumbosacral radiculopathy, a detailed neurological examination of both lower limbs is required.

Management

Rest/training adaptations, Anti-inflammatory medication(?), Ice, Injections, Stretching, massage / myofascial release, Muscle balance re-training, Core strength exercises, Correction of biomechanical abnormalities (eg. Orthotics), bike fit adjustment, ensuring appropriate footwear, Surgical treatment- rare (Bursectomy).