Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis)

Excerpt

Patients diagnosed with lateral hip pain are commonly treated for trochanteric bursitis using non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and physical therapy. While effective for many, this approach still leaves many patients with ongoing discomfort and limited functionality. Recent advancements in understanding have led to the recognition of greater trochanteric pain syndrome (GTPS) as a more accurate descriptor of this condition. GTPS encompasses trochanteric bursitis, external coxa saltans (snapping hip), and abductor tendinopathy.

Trochanteric bursitis, the predominant cause of GTPS, involves inflammation of the greater trochanteric bursa, which is located between the greater trochanter and the iliotibial band. This inflammation is commonly triggered by repetitive stress and trauma. The condition manifests as pain in the lateral thigh, often aggravated by prolonged sitting, stair climbing, or engaging in high-impact exercises. The hip joint, bearing loads of 6 to 8 times the body weight during everyday activities, is particularly vulnerable to wear and tear.

The diagnosis of GTPS is primarily clinical, with imaging used to differentiate it from other potential causes. A deep understanding of the relevant anatomy, clinical examination findings, and imaging results is essential in managing cases resistant to conservative treatment. The standard treatment includes NSAIDs, physical therapy, and stretching exercises. Surgical intervention, both open and endoscopic, is reserved for cases where conservative methods are ineffective.

Involved Anatomical Structures

Dysfunction at any anatomical junction can manifest as greater trochanteric pain syndrome. The peritrochanteric space contains important anatomical structures that enable hip motion and stability. A key structure is the subgluteus maximus bursa, also called the trochanteric bursa, which cushions movements of the overlying gluteus tendons, iliotibial band, and tensor fascia lata. The peritrochanteric space is superficially covered by a fibromuscular sheath comprising the gluteus maximus, tensor fascia lata, and iliotibial band. Underneath lie the hip abductor and stabilizer muscles. The gluteus minimus stabilizes the femoral head, originating from the pelvis and inserting at the greater trochanter. The larger gluteus medius also inserts at the greater trochanter, initiates hip abduction, and stabilizes the femoral head. Finally, the tensor fascia lata forms the prime hip abductor. Proper functioning of these muscular and connective tissue structures enables painless motion and transfers weight laterally from the hip during gait.