Lateral thigh pain/ trochanteric bursitis (greater trochanter pain syndrome)

According to Nice 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. Recent evidence now suggests it is primarily caused by pathology of the gluteal tendons, particularly gluteus medius and minimus. Gluteal tendinopathy can be associated with trochanteric bursal ‘distension’ but research does not support the presence of an inflammatory bursitis. Isolated bursal pathology is rare and if present is
almost always associated with a tendinopathy.

In a study by Reid 2015¹, the annual incidence of trochanteric pain was reported as being 1.8-5.6/1000. More common in women than men with a ratio of 4:1 and increased prevalence in 40-60 age group Chowdhury et al 2014²- hypothetically is this due to menopausal changes and weakness in core muscle groups.

Corticosteroid injections are not recommended as treatment for trochanteric bursitis within primary care or secondary care.

References:-

1. Reid D. The management of greater trochanteric pain syndrome: A systematic literature review. J Orthop. 2016 Jan 22;13(1):15-28. doi: 10.1016/j.jor.2015.12.006. PMID: 26955229; PMCID: PMC4761624.
2. Chowdhury R, Naaseri S, Lee J, Rajeswaran G. Imaging and management of greater trochanteric pain syndrome. Postgrad Med J. 2014 Oct;90(1068):576-81. doi: 10.1136/postgradmedj-2013-131828. Epub 2014 Sep 3. PMID: 25187570.

Direct injury-direct impact to the greater trochanter/hip area- resulting in bursitis/tendinopathy.

Chronic injury- repetitive strain/overloading of tendons- in work situations and sport.

Inflammatory disease-RA/gout/calcific tendonitis-bursitis.

• Palpation around greater trochanter is painful
• Single leg stand reproduces pain
• Trendelenburg’s sign
  FADER (Flexion, Adduction, External Rotation)
• Resisted abduction in side-lying.

Not indicated in Primary Care.

• Lumbar spine/ radiculopathy (especially in bilateral symptoms)
• An inability to actively abduct the hip in side-lying would likely indicate a large abductor tear or possible rupture.

• 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 antiinflammatory drug such as ibuprofen, if needed.
  • Advised that losing weight may help reduce symptoms (if appropriate).
  • Strengthening and mobilising programme will restore previous function levels.
• NHS AAA MSK website.
• NHS Inform. Greater trochanter pain syndrome.
• NHS Inform. Self-help guide: Lower back pain.
• NHS A&A. Greater trochanteric pain syndrome (GTPS)

Diagnostically uncertain.
Symptoms persist beyond 2- 3/12 and interfere with ADLs despite conservative management.