Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology

Abstract

Greater trochanteric pain syndrome is a common cause of lateral hip pain, encompassing a spectrum of disorders, including trochanteric bursitis, abductor tendon pathology, and external coxa saltans. Greater trochanteric pain syndrome is primarily a clinical diagnosis, and careful clinical examination is essential for accurate diagnosis and treatment. A thorough history and physical exam may be used to help differentiate greater trochanteric pain syndrome from other common causes of hip pain, including osteoarthritis, femoroacetabular impingement, and lumbar stenosis. Although not required for diagnosis, plain radiographs and magnetic resonance imaging may be useful to exclude alternative pathologies or guide treatment of greater trochanteric pain syndrome. The majority of patients with greater trochanteric pain syndrome respond well to conservative management, including physical therapy, non-steroidal anti-inflammatory drugs, and corticosteroid injections. Operative management is typically indicated in patients with chronic symptoms refractory to conservative therapy. A wide range of surgical options, both open and endoscopic, are available and should be guided by the specific etiology of pain. The purpose of this review is to highlight pertinent clinical and radiographic features used in the diagnosis and management of greater trochanteric pain syndrome. In addition, treatment indications, techniques, and outcomes are described.

Keywords: Greater trochanteric pain syndrome; endoscopy; surgery; tendinopathy; trochanteric bursitis.

Figure 1.

Flow diagram illustrating initial search yield and articles excluded based on prespecified criteria. *As a narrative review, final eligibility for inclusion was at the authors’ discretion based on relevance and importance to the topic.

Figure 2.

Anatomy of the greater trochanter. (a) Three peritrochanteric bursae, (b) osseous facets of the greater trochanter, and (c) insertion sites for the abductor tendons.

Figure 3.

Evaluation of hip abductor strength. The patient lies in the lateral decubitus position with the affected side facing up. With the hip and knee extended, the examiner asks the patient to abduct the hip against resistance.

Figure 4.

Trendelenburg test. From a (a) standing position, (b) the patient is asked to stand on the affected leg and lift the contralateral foot off the ground. The test is considered positive, if the contralateral pelvis tilts downward, indicating abductor weakness.

Figure 5.

(a) Coronal fat suppressed proton density and (b) sagittal T2-weighted sequences on MRI of the right hip showing a high-grade partial tear of the gluteus medius and minimus tendons with tendinosis and underlying trochanteric bursitis. The patient consented for publication of this imaging.

Figure 6.

(a) Coronal T1-weighted and (b) short tau inversion recovery (STIR), sequences on MRI with a chronic, full-thickness tear of the left gluteus medius and minimus tendons with significant fatty atrophy of the abductors. The patient consented for publication of this imaging.