Overview of greater trochanteric pain syndrome

Figure 1. Key practice points for greater trochanteric pain syndrome.

[NB1]

  • The most common symptom of greater trochanteric pain syndrome is lateral thigh pain, most likely associated with tendinopathy affecting the gluteus medius and minimus tendons.
  • Diagnosis is usually clinical.
  • Investigation may over-diagnose tendinopathy; many tendon tears seen radiologically are asymptomatic.
  • Treatment is symptomatic with oral analgesia, avoidance of aggravating activities, support for the person’s mental health and gradual reintroduction to exercise (including a progressive-loading program).
  • Local corticosteroid injection can be used for short-term symptomatic relief of tendinopathic pain.
Note: NB1: This list is a summary guide only; refer to full text.

Lateral thigh pain is a common problem with a prevalence of 17% in those aged 50 to 79 yearsBoyd, 2020. Lateral thigh pain is felt in the region of the greater trochanter and is exacerbated by lying on that side, often disturbing sleep. Historically, lateral thigh pain has been referred to as trochanteric bursitis, but pain felt in this region may be associated with various local pathologies involving the:

  • gluteus medius and minimus tendons, most commonly gluteal tendinopathy
  • iliotibial band
  • bursa superficial to the lateral aspect of the greater trochanter, or several smaller local bursae.

Although the preferred terminology for this regional pain is greater trochanteric pain syndrome, there are many potential aetiologies that require different management. Pain felt in this region may also be referred from the hip, buttock, sacro-iliac joint(s) or lower back (specifically L2 and L3 dermatomes); such referred pain is not included in the spectrum of greater trochanteric pain syndrome.

Greater trochanteric pain syndrome associated with lateral thigh pain is more common in women, with some studies indicating a gender ratio of 4:1Barratt, 2017.

Magnetic resonance imaging (MRI) and ultrasound scans have indicated that gluteal tendinopathy is the most frequent radiological finding, whereas bursal distension (indicative of bursitis) is relatively uncommon. One study indicated that trochanteric bursitis was found radiologically in only 6% of cases of greater trochanteric pain syndromeBoyd, 2020.