Greater Trochanteric Pain Syndrome or Hip ‘Bursitis’?
Greater Trochanteric Pain Syndrome (GTPS) is a term used to describe the condition previously often inaccurately diagnosed as trochanteric bursitis.
Bursae are fluid filled sacs that provide cushioning between bony prominences and overlying tissues. Trochanteric bursitis was previously used to indicate inflammation of the bursa of the lateral hip that are located between the greater trochanter (bone on the outer hip) and the overlying gluteus tendons (buttock muscles), iliotibial band (ITB) and tensor fascia lata (TFL).
A clinical diagnosis included both an aching lateral hip pain and distinct tenderness around the greater trochanter, pain on moving the leg to the side, pain when lying on that side, pain with prolonged standing, and pain increased by walking and running.
Epidemiology studies suggest that these symptoms are a common complaint amongst active and sedentary individuals, have a higher prevalence in women (4:1), are most commonly found in those 50-70 years of age and have no racial predilection.
Trochanteric bursitis may be classified as either an acute injury or a repetitive irritation. Acute injuries may occur due to impact from falls, sports or other high impact trauma. Repetitive traumas are usually due to irritation from the friction of the iliotibial band (ITB) rubbing over the trochanter during continuous flexion and extension of the hip. This type of irritation is most often seen in runners, however is not exclusive of less active individuals.
The term ‘trochanteric bursitis’ has been substituted for GTPS as current research using ultrasound and medical resonance imaging highlights a paucity of evidence supporting the inflammatory process of the condition. This evidence also identifies that in the majority of patients with pain and tenderness over the greater trochanter, the bursae are not involved, emphasizing instead tendinosis or tears of the gluteal muscles as the primary cause of the pain. These signs and symptoms are often secondary to other pathologic conditions that have been caused by biomechanical deficiencies that can be treated with physiotherapy.
Conditions that may be causative of GTPS include;
- Chronic mechanical low back pain
- Degenerative arthritis or disc disease of lower lumbar spine
- Degenerative joint disease of knees
- Patellofemoral pain
- Iliotibial band syndrome
- Inflammatory arthritis of the hip
- Ipsilateral or contralateral hip arthritis
- Anterior hip impingement
- Leg length discrepancy
- Pes planus or excessive pronation
- Tendonitis of external hip rotators
- Total hip arthroplasty
- Hip abductor weakness
All of these factors can be treated and improved with physiotherapy. Whilst cortisone injections into the hip can reduce your pain, they do not fix the underlying biomechanical deficiency and therefore without correction many people develop chronic hip or other secondary problems. Cortisone can be used to decrease pain and therefore allow physiotherapy to correct underlying deficits. Present to your physiotherapist today for a full assessment and correction. We will direct you appropriately should we feel that a local injection will make your rehabilitation easier. Ultimately avoid an injection until you try conservative management.
Written by Scott Ward