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Greater trochanteric pain syndrome (formerly Trochanteric bursitis)

Juan J Canoso, MD, MACR
Section Editor
Zacharia Isaac, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


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 [1]. 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 [2]. 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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Literature review current through: Oct 2015. | This topic last updated: Jun 19, 2015.
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  1. Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 2007; 88:988.
  2. Fearon AM, Scarvell JM, Neeman T, et al. Greater trochanteric pain syndrome: defining the clinical syndrome. Br J Sports Med 2013; 47:649.
  3. Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum 2001; 44:2138.
  4. Fearon AM, Twin J, Dahlstrom JE, et al. Increased substance P expression in the trochanteric bursa of patients with greater trochanteric pain syndrome. Rheumatol Int 2014; 34:1441.
  5. Lequesne M, Mathieu P, Vuillemin-Bodaghi V, et al. Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. Arthritis Rheum 2008; 59:241.
  6. Hoffmann A, Pfirrmann CW. The hip abductors at MR imaging. Eur J Radiol 2012; 81:3755.
  7. Sutter R, Kalberer F, Binkert CA, et al. Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle. Skeletal Radiol 2013; 42:627.
  8. Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat 2006; 208:309.
  9. Pfirrmann CW, Chung CB, Theumann NH, et al. Greater trochanter of the hip: attachment of the abductor mechanism and a complex of three bursae--MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers. Radiology 2001; 221:469.
  10. Lequesne M. From "periarthritis" to hip "rotator cuff" tears. Trochanteric tendinobursitis. Joint Bone Spine 2006; 73:344.
  11. Woodley SJ, Mercer SR, Nicholson HD. Morphology of the bursae associated with the greater trochanter of the femur. J Bone Joint Surg Am 2008; 90:284.
  12. Fearon AM, Cook JL, Scarvell JM, et al. Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. J Arthroplasty 2014; 29:383.
  13. Trendelenburg F. Trendelenburg's test: 1895. Clin Orthop Relat Res 1998; :3.
  14. Jamaluddin S, Sulaiman AR, Imran MK, et al. Reliability and accuracy of the tape measurement method with a nearest reading of 5 mm in the assessment of leg length discrepancy. Singapore Med J 2011; 52:681.
  15. Gajdosik RL, Sandler MM, Marr HL. Influence of knee positions and gender on the Ober test for length of the iliotibial band. Clin Biomech (Bristol, Avon) 2003; 18:77.
  16. Martin HD. Clinical examination of the hip. Oper Tech Orthop 2005; 15:177.
  17. Martin HD, Palmer IJ. History and physical examination of the hip: the basics. Curr Rev Musculoskelet Med 2013; 6:219.
  18. Steinert L, Zanetti M, Hodler J, et al. Are radiographic trochanteric surface irregularities associated with abductor tendon abnormalities? Radiology 2010; 257:754.
  19. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol 2013; 201:1083.
  20. Ho GW, Howard TM. Greater trochanteric pain syndrome: more than bursitis and iliotibial tract friction. Curr Sports Med Rep 2012; 11:232.
  21. Lequesne M, Bellaïche L. Anterior femoroacetabular impingement: an update. Joint Bone Spine 2012; 79:249.
  22. Leunig M, Beck M, Dora C, Ganz R. Femoroacetabular impingement: etiology and surgical concept. Oper Tech Orthop 2005; 15:247.
  23. Reich MS, Shannon C, Tsai E, Salata MJ. Hip arthroscopy for extra-articular hip disease. Curr Rev Musculoskelet Med 2013; 6:250.
  24. Tortolani PJ, Carbone JJ, Quartararo LG. Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists. Spine J 2002; 2:251.
  25. Visser LH, Nijssen PG, Tijssen CC, et al. Sciatica-like symptoms and the sacroiliac joint: clinical features and differential diagnosis. Eur Spine J 2013; 22:1657.
  26. Martin HD, Shears SA, Johnson JC, et al. The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Arthroscopy 2011; 27:172.
  27. KOPELL HP, THOMPSON WA, POSTEL AH. Entrapment neuropathy of the ilioinguinal nerve. N Engl J Med 1962; 266:16.
  28. Traycoff RB. "Pseudotrochanteric bursitis": the differential diagnosis of lateral hip pain. J Rheumatol 1991; 18:1810.
  29. Deal CL, Canoso JJ. Meralgia paresthetica and large abdomens. Ann Intern Med 1982; 96:787.
  30. Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med 2011; 21:447.
  31. McEvoy JR, Lee KS, Blankenbaker DG, et al. Ultrasound-guided corticosteroid injections for treatment of greater trochanteric pain syndrome: greater trochanter bursa versus subgluteus medius bursa. AJR Am J Roentgenol 2013; 201:W313.
  32. Shbeeb MI, O'Duffy JD, Michet CJ Jr, et al. Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol 1996; 23:2104.
  33. Brinks A, van Rijn RM, Willemsen SP, et al. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med 2011; 9:226.
  34. Lequesne M, Djian P, Vuillemin V, Mathieu P. Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. Clinical and MRI results of tendon repair. Joint Bone Spine 2008; 75:458.
  35. Verhelst L, Guevara V, De Schepper J, et al. Extra-articular hip endoscopy: A review of the literature. Bone Joint Res 2012; 1:324.