Greater trochanteric pain syndrome (GTPS) is a term used to describe chronic pain in the outer lateral part of the hip. Previously, it was believed that the only cause of pain in this region was trochanteric bursitis, but today we know that the most common cause of greater trochanteric pain syndrome is problems related to the gluteal tendons. It is noted that the incidence of GTPS is higher in women, patients with low back pain, those with iliotibial band tension, and patients with obesity.
Symptoms of GTPS include persistent pain on the outer side of the hip that radiates along the lateral thigh to the knee, and sometimes below the knee or to the gluteal muscles. During a physical examination, tenderness is often detected in the posterolateral area of the greater trochanter.
GTPS is typically treated with non-surgical methods such as rest, personalized strengthening and stretching exercise programs guided by a physiotherapist, cortisone injections targeting the bursa around the greater trochanter, and PRP injections directed at the gluteal tendons. In cases where these treatments fail, arthroscopic surgeries, including IT band release or gluteal tendon repair, may be required.
What is the Trochanter?
The trochanter is one of the protrusions on the femur (thigh bone) and is an essential part of the hip joint. The greater trochanter, located on the outer hip, serves as the attachment point for the gluteus medius and minimus muscles, which are responsible for hip movement and preventing a waddling gait while walking or running. Commonly, it is referred to as the bony prominence on the outer side of the hip. When lying on your side in bed, if you feel a hard bump where your hip contacts the mattress, it is likely the greater trochanter.
What is Greater Trochanteric Pain Syndrome?
GTPS is a general umbrella term used to describe painful conditions around the bony prominence called the greater trochanter on the lateral side of the hip, characterized by pain and tenderness in this area.
Causes of Pain in Greater Trochanteric Pain Syndrome:
Gluteus medius and minimus tendon issues: For more detailed information on gluteus medius tendon tears, click here: [Link]
Inflammation of the bursa structures in the gluteal region (bursitis): For more information on trochanteric bursitis, click here: [Link]
Tightness of the IT band: As the IT band shortens, it rubs against the greater trochanter, causing inflammation and pain. This condition is called proximal iliotibial band friction syndrome. For more information on IT band syndrome, click here: [Link]
What are the Symptoms of Greater Trochanteric Pain Syndrome?
Pain: The most common symptom of GTPS is pain around the greater trochanter, especially on the lateral and slightly posterior aspect of the hip. The pain typically worsens after daily activities and physical exercises. Pressure on the area also increases the pain. Many patients report difficulty lying on the affected side at night, waking up from sleep due to discomfort. The pain also intensifies during the single-leg stance phase of walking or running. Patients often mention pain in the outer hip when trying to put on socks while standing.
Limping: This is more commonly seen in cases of gluteal medius and minimus tendon issues.
Who is at Risk for Greater Trochanteric Pain Syndrome?
GTPS is more common in women aged 40-60 but can occur in individuals of all age groups.
Women are four times more likely to develop GTPS compared to men, likely due to the relatively wider pelvic structure in women.
People with IT band tightness are at higher risk for GTPS.
GTPS is more frequent in overweight individuals.
Weakness in muscles important for leg and hip movement and stability, such as the gluteus maximus and gluteus medius, increases the risk of GTPS.
Sacroiliac dysfunction, which can cause leg length discrepancies and alter walking or running biomechanics, increases the risk of GTPS.
People with scoliosis are also at higher risk.
Runners, cyclists, and triathletes who suddenly increase their training intensity are more likely to develop GTPS.
How is Greater Trochanteric Pain Syndrome Diagnosed?
There is no standard method for diagnosing GTPS. Patients with complaints of pain on the lateral hip undergo a detailed evaluation. The diagnosis is confirmed by ruling out other conditions in the area and using imaging methods such as ultrasound and MRI.
In many patients, determining the exact cause of GTPS is not easy. Most patients have biomechanical issues in the lower extremities. A shortened and less flexible IT band increases friction in the greater trochanter region, leading to conditions such as trochanteric bursitis, gluteus medius and minimus tendon diseases (tendinosis), or tears in these tendons.
How is Greater Trochanteric Pain Syndrome Treated?
Treatment for GTPS is aimed at addressing the underlying cause. The treatment typically begins with weight control, pain medications, ice application, and targeted physiotherapy programs. Patients are also advised to avoid crossing their legs. Placing a pillow between the legs while sleeping can help reduce pressure on the greater trochanter. Physiotherapy focuses on strengthening the gluteus maximus, gluteus medius, and minimus muscles, while relaxing the IT band and tensor fascia lata structures.
In some patients, pain arises from biomechanical abnormalities, with the most common cause being a shortened and tight IT band. If adequate stretching is not done after physical activities, the IT band may shorten over time, leading to problems in the knee and, less commonly, the hip. Physiotherapy and functional strength exercises can completely resolve this issue.
Greater Trochanteric Pain Syndrome Cortisone Treatment: Ultrasound-Guided Injection
If the problem is trochanteric bursitis, 1 or 2 cortisone injections under ultrasound guidance can easily treat the condition. For more information on trochanteric bursitis treatment, click here.
Greater Trochanteric Pain Syndrome PRP Treatment: Ultrasound-Guided PRP Injection
If the issue is related to a gluteus medius tendon tear, cortisone injections may not improve the condition and could even worsen the pain in some patients. If the tear is small, PRP injections under ultrasound guidance are performed as the first step. If the tear is large and causes limping while walking, surgery is the definitive treatment. Gluteus medius tendon tears can be repaired using minimally invasive arthroscopic surgery.
Greater Trochanteric Pain Syndrome Surgical Treatment Options
GTPS is generally treated with non-surgical methods described above. However, surgery may be considered when these treatments are insufficient, or the symptoms become severe and persistent. The surgical options for GTPS include:
Endoscopic Bursa Excision (Bursectomy): This procedure involves removing the inflamed bursa around the trochanter. It is a minimally invasive procedure with small incisions, and the recovery time is usually quick. The aim is to reduce friction and pain by removing the bursa.
Tendon Repair: If there is damage or a tear in the gluteus medius tendon where it attaches to the greater trochanter, the tendon can be repaired using endoscopic methods.
Removal of Bone Spurs (Osteophytes): Bone spurs that develop on the greater trochanter can irritate the tendons and bursa, causing inflammation. These bone spurs can be surgically removed, reducing pressure and friction in the area.
Iliotibial Band Release: If the IT band is too tight, it can put excessive pressure on the hip, causing pain. In this case, endoscopic surgery can be performed to release or loosen the IT band.
