Greater trochanteric pain syndrome (formerly trochanteric bursitis)
- Juan J Canoso, MD, MACR
Juan J Canoso, MD, MACR
- ABC Medical Center, México City, Mexico
- Adjunct Professor of Medicine, Tufts University School of Medicine, Boston, MA
Greater trochanteric pain syndrome (GTPS) is one of the most common causes of lateral hip pain in adults. In most instances, GTPS is due to a gluteus medius or minimus tendinopathy, with variable involvement of the regional bursae.
Historically, the term “trochanteric bursitis” was used to describe any pain around the lateral hip. However, advanced imaging and histopathological studies have shown that involvement of the trochanteric bursae in patients with lateral hip pain is uncommon and, when present, exists as a secondary or associated finding. Thus, trochanteric bursitis is a misnomer when it used to describe all causes of lateral hip pain. In fact, primary trochanteric bursitis is rare and is typically of microbial etiology.
The clinical presentation, diagnosis, differential diagnosis, and management of GTPS are reviewed here. An overview of bursitis and the musculoskeletal examination of the hip and groin are presented separately. (See "Bursitis: An overview of clinical manifestations, diagnosis, and management" and "Musculoskeletal examination of the hip and groin".)
Greater trochanteric pain syndrome (GTPS) is common. The best estimates of prevalence are from a large, community-based study with over 3000 adults aged 50 to 70 years, in which unilateral GTPS was present in 15 percent of women and 6.6 percent of men . Bilateral GTPS was reported in 8.5 and 1.9 percent of women and men, respectively. The usual age at presentation is over 50 years, and the female to male ratio is approximately 4:1.
Risk factors for greater trochanteric pain syndrome (GTPS) include female gender, obesity, knee pain, iliotibial band tenderness, and low back pain . Other conditions associated with GTPS include scoliosis; a leg length discrepancy; articular conditions of the hip, knee, and foot; and painful foot disorders such as plantar fasciitis, Achilles tendinopathy, a bunion, a Morton’s neuroma, or a callus.
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- RISK FACTORS
- RELEVANT ANATOMY
- DIAGNOSTIC EVALUATION
- Clinical presentation
- Physical examination
- - Specific manuevers
- - Conventional radiography
- - Ultrasonography
- - Magnetic resonance imaging
- DIFFERENTIAL DIAGNOSIS
- Initial therapy
- Persistent symptoms
- - Glucocorticoid injection
- - Surgery
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS