Greater Trochanteric Pain Syndrome (GTPS)

Patients often describe an insidious onset of lateral hip pain, with them typically able to pinpoint symptoms quite easily to the greater trochanteric attachment site. They are focally tender with local compression; hip movements are typically preserved and unprovocative but end-of-range external rotation can provoke symptoms (FABER’s test) due to the lengthened/stretched position of the gluteal tendons. Resisted testing of the abductors can also provoke symptoms.Source: Greater Trochanteric Pain Syndrome – PubMed (opens in a new tab)

The condition is aggravated with periods of ambulation and climbing stairs; sleeping becomes difficult and disturbed, especially when lying on the affected side due to localised compression. Symptoms can on occasions radiate down the anterolateral thigh to the level of the knee.

GTPS is typically a clinical diagnosis. An x-ray may be arranged to exclude any arthrosis in the hip joint, as sometimes the clinical picture can be unclear. Ultrasound and MRI can confirm the changes to the gluteal tendons and trochanteric bursae but are not routinely needed to make the diagnosis if your clinical symptoms are clear.Source: Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology – PubMed (opens in a new tab)

Ultrasound does, however, allow for targeted intervention and aspiration of distended bursae, which can provide an additional therapeutic benefit, and assessment of any concurrent pathology, such as tendon tears and hydroxyapatite deposition (calcification), that can on occasion be amenable to specific treatment.

For the most part, this condition is treated conservatively.

• Advice/education, activity modification +/- analgesia/short course of NSAIDs. In some cases, all that is needed is a change in sleeping habits (avoiding compression positions and prolonged stretched positions of the gluteal tendons, e.g., cross-legged sitting) and a period of unloading to allow things to settle.
• If symptoms persist, the first-line management is physiotherapy. It follows the basic principles of any tendinopathic tendon. This is a structured and progressive rehab programme to improve the tolerance and capacity of the gluteal tendons. Shockwave therapy is a non-invasive adjunct that some patients find helpful in settling their lateral hip pain.Source: Extracorporeal Shockwave Therapy for Greater Trochanteric Pain Syndrome: A Systematic Review with Meta-Analysis of Randomised Clinical Trials – PubMed (opens in a new tab)
• In persisting cases an ultrasound-guided steroid and local anaesthetic injection into the trochanteric bursa can be helpful. Further compliance with physiotherapy is important afterwards to allow the best prognosis.Source: Comparison of the effects of ultrasound-guided steroid injection and anatomic landmark-guided injection on pain and disability in greater trochanteric pain syndrome – PubMed (opens in a new tab)
• An ultrasound-guided PRP injection is a potential alternative to repeated steroid injections in refractory cases that can be helpful in carefully selected patients. However, the long-term efficacy remains a matter of debate.Sources: Greater Trochanteric Pain Syndrome and the Efficacy of Platelet-Rich Plasma Injections: A Systematic Review – PMC (opens in a new tab); Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome: A Double-Blinded Randomised Controlled Trial – PubMed (opens in a new tab)

Surgical intervention

• Surgery is rarely indicated and usually the last resort for patients with isolated GTPS, as the general consensus is that outcomes are usually poor, with many patients still experiencing symptoms postoperatively. However, for refractory and severe cases surgical intervention may be considered, which can include gluteal tendon repair and ITB release +/- bursectomy through both open and endoscopic techniques with positive outcomes reported for carefully selected patients.Source: Good functional outcomes after endoscopic treatment for greater trochanteric pain syndrome – PubMed (opens in a new tab)