Patients commonly present to GPs with hip pain, and one diagnosis often suggested is trochanteric bursitis. The evidence suggests that the pain is not always related to an inflammatory condition or to one of the bursae around the hip, so the term Greater Trochanteric Pain Syndrome (GTPS) is now favoured.
GTPS is a common cause of lateral hip pain. Most cases respond to conservative treatments with few refractory cases requiring surgical intervention. For many years, this condition was believed to be caused by trochanteric bursitis, with treatments targeting the bursa. More recently, gluteal tendinopathy or tears have been proposed as potential causes. Treatments are developing to target these proposed pathologies but at present there is no defined treatment protocol for GTPS (Reid, 2016). Treatments that have been shown to be effective include NSAIDs. There have been no studies for eccentric exercise but their benefits for other tendinopathies would suggest this may be effective. There is strong evidence for short-term benefit from corticosteroid injections but recurrence of symptoms is common. Low-energy extracorporeal shockwave therapy has been shown to be effective but the mechanism is unclear. Platelet-rich plasma or whole blood injections may also be effective. Surgery has been shown to be effective in refractory cases but the evidence base is limited. Positive results have been shown for gluteal tendon repair, iliotibial band release or lengthening, and trochanteric bursectomy.
One hundred and sixty-four general practice patients with incidental trochanteric pain were sent a questionnaire as part of a retrospective cohort study. The incidence of GTPS was 1.8 patients per 1000 per year. After a year at least 36% still suffered from trochanteric pain and after five years this was down to 29%. Patients who had a diagnosis of osteoarthritis in the lower limbs had a 4.8-fold increased risk of persistent symptoms compared to those without OA. Patients who received a corticosteroid injection were 2.7 times more likely to recover after five years compared to those who did not have an injection (Lievense et al., 2005).
A cross-sectional community study of adults between ages 50 and 79 with hip pain but without OA or generalised myofascial pain found the prevalence of unilateral and bilateral GTPS was 15% and 8.5% in women and 6.6% and 1.9% in men. Age and race were not significantly associated with GTPS, but the OR for women was 3.37 (95% CI 2.67-4.25). Iliotibial band tenderness, ipsilateral knee OA and contralateral knee OA were all associated with GTPS but BMI was not. Hip internal rotation range of motion did not differ based on GTPS status. After multivariate adjustment, GTPS did not alter physical activity score, but bilateral GTPS was significantly associated with a higher 20m walk time and chair stand time (Segal et al., 2007).
LIEVENSE, A., BIERMA-ZEINSTRA, S., SCHOUTEN, B., BOHNEN, A., VERHAAR, J. & KOES, B. 2005. Prognosis of trochanteric pain in primary care. Br J Gen Pract, 55, 199-204.
REID, D. 2016. The management of greater trochanteric pain syndrome: A systematic literature review. J Orthop, 13, 15-28.
SEGAL, N. A., FELSON, D. T., TORNER, J. C., ZHU, Y., CURTIS, J. R., NIU, J. & NEVITT, M. C. 2007. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil, 88, 988-92.