Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis)

Abstract

Greater trochanteric pain syndrome is a regional pain syndrome in which chronic intermittent pain is felt around the greater trochanter (the bony prominence on the lateral aspect of the hip). The term 'trochanteric bursitis' (inflammation of a bursa adjacent to the greater trochanter) was previously used for what is now known as 'greater trochanteric pain syndrome'. The inclusive term 'greater trochanteric pain syndrome' is preferred as the trochanteric bursae play a smaller role than was previously thought and inflammation is not always present. Greater trochanteric pain syndrome is: Caused by inflammation or physical trauma in muscles, tendons, fascia, or bursae. More common in women than in men, especially in women between 40–60 years of age. Frequently seen together with other conditions such as low back pain, osteoarthritis of the knee, rheumatoid arthritis, and fibromyalgia. Over 90% of people with greater trochanteric pain syndrome recover fully with conservative treatment such as rest, pain relief, physiotherapy, and corticosteroid injection. Risk factors for a poorer outcome include higher initial pain intensity, longer duration of pain, greater movement restriction, higher functional impairment, and older age. The diagnosis of greater trochanteric pain syndrome is made on clinical grounds. Core clinical features include lateral hip pain, point tenderness adjacent to the greater trochanter, and a positive Trendelenburg test. The location, radiation, nature, and onset of pain, and what aggravates or relieves it should be determined. Point tenderness and evidence of pain when muscles and tendons attached to the greater trochanter are put under tension should be assessed on examination. Alternative diagnoses, for example sports hernia, osteoarthritis, lumbar nerve root compression, and infection of the bursa should be excluded. A person presenting with greater trochanteric pain syndrome should be: Reassured that the condition is usually self-limiting. Advised to avoid activity which may worsen the pain such as repetitive hip movements or lying on the affected hip. Advised that an ice pack applied for 10–20 minutes several times a day may relieve symptoms. Advised on analgesia such as paracetamol or a nonsteroidal anti-inflammatory drug such as ibuprofen, if needed. Advised that losing weight may help reduce symptoms (if appropriate). If initial conservative treatment does not provide adequate symptom relief, a peri-trochanteric corticosteroid injection and referral to physiotherapy should be offered. If there are signs of infected bursitis such as a tender palpable mass, redness, oedema, or warmth, the person should be referred urgently to an orthopaedic surgeon. A rheumatologist or orthopaedic surgeon should be consulted if: There is doubt about the diagnosis. Expertise in peri-trochanteric injections is not available in primary care. An orthopaedic surgeon should be consulted if the symptoms: Are related to previous hip surgery or fracture of the femur. Persist after peri-trochanteric corticosteroid injection and/or physiotherapy