Greater Trochanteric Pain Syndrome

Greater Trochanteric Pain Syndrome

Greater trochanteric pain syndrome (GTPS or also known as trochanteric bursitis) is a condition caused by an inflammatory response or injury to the soft tissues connecting onto the bony prominence (greater trochanter) of the femur head. It results in pain over the lateral side of the top of the thigh. Many complain of the pain as a ‘deep’ pain which aches or burns and/or worsens over time or when lying on your side; walking with a limp; or being exasperated with exercise.

GTPS used to be called trochanteric bursitis as originally it was thought that the pain was caused by inflammation to the connecting bursa (a small fluid-filled sac allowing smooth movements between two irregular surfaces). It has now become evident thought that most cases of GTPS is actually caused by minor tears or damage to the connecting muscles, tendons, or fascia.

Greater trochanteric pain syndrome is relatively common and mostly affects people over the age of 50 (one study found it affected 1:4 in women and 1:10 in men). Although much less common, it has known to affect people of a younger age, especially if they are runners.

Causes of this syndrome can be any of the following or even a combination of factors:

• A traumatic injury or fall directly on the hip area.
• Overuse repetitive movements of the hip joint (e.g. excessive walking or running).
• Some infections (e.g. tuberculosis) and some diseases (e.g. gout or arthritis) can cause, exasperate inflammation of the bursa.
• Prolonged pressure or load to the hip area (e.g. sitting in bucket car seats for a long time).
• A leg-length discrepancy will increase the risk of developing GTPS.
• The presence of residual scar tissue, implants or surgical materials (wire, screws etc.).

What is the treatment protocol?

The good news is that GTPS usually goes away on its own over time. Usually, this time frame is a few weeks but can persist for months, or even in a small minority of cases, longer than that! If the pain persists, it is important to remember that this is not indicative of another underlying complication or that there is structural damage to the hip joint.

Most of the treatment is on managing the pain symptom and on not aggravating the hip thereby speeding up the recovery process. These can include:

• Decreasing any activity that aggravates the hip area (e.g. running).
• Cryotherapy (ice) will help and one recommends icing the affected area a few times a day (10-20min per time).
• Speak to your doctor regarding taking anti-inflammatories and/or paracetamol to control pain and assist with the inflammation.
• If the person carries excess weight, losing weight will decrease the load being taken through the affected hip.
• A sports physician could inject a steroid complex to assist with inflammatory response.
• Physiotherapy will help in maintaining full hip mobility and specific strengthening will help to offload stress on the affected area.