Greater Trochanteric Pain Syndrome Flashcards
Which patient population is greater trochanteric pain syndrome most common
Women and middle-aged or elderly individuals
*bc hips are wider there is more pressure at the sides of the hips
What is the etiology of greater trochanteric pain syndrome
From overuse
*or more commonly due to tendinopathy of the gluteus medius/and or minimus with or without evidence of bursitis
What is the pathophysiology of greater trochanteric pain syndrome
- Inflammation of the trochanteric bursa between the greater trochanter and the gluteus medius/iliotibial band
OR - Gluteus medius and/or minimus
How can abnormal hip biomechanics lead to gluteal tendinopathies?
- Compressive forces can cause impingement of gluteal tendons and bursa onto the greater trochanter by the ITB as the hip moves into adduction
If there is ischial bursitis where will the patient feel pain?
- Deep in the butt
If there is iliopsoas bursitis where will pain be?
- In the groin area
How to complete CI for trochanteric bursitis?
- Feel for the greater trochanter
- Push in until bone, then pull back 1mm
What are some risk factors of greater trochanteric pain syndrome
- Leg-length discrepancy
- Poor posture
- Poor footwear
- Improper technique
What is the clinical presentation of greater trochanteric pain syndrome
- Lateral thigh/hip pain
- Radiation down thigh (typically laterally)
*wont radiate down to feet - Pain with lying on affected side
- Pain with stairs
What will be found on the PE?
- Point tenderness over the greater trochanter
- Swelling
- Exacerbation by hip ROM (IR/ER)
- Decreased muscle strength (secondary to pain)
- May be tender over the ITB from hip to knee
- Groin pain with internal rotation
*indicated hip pathology such as arthritis or lateral tearing - Assess for lumbosacral ridiculopathy
What are the diagnostic findings?
- Can be made as a clinical diagnosis with no testing (just from H&P)
*if conservative treatment fails then further eval - Plain radiographs
- MRI
*asses for fracture - Bone scan
- Diagnostic injection
*works mainly with bursitis
What is the treatment of greater trochanteric pain syndrome
- Conservative
*stretch and NSAIDs, heat - Avoid aggravating activities
- Avoid lying on affected side
*pillow between knees when on contralateral side - Cortisone injection
- PT and stretching of ITB
What is the injection technique for greater trochanteric pain syndrome
- Use a numbing agent + steroid
- Start with a 2in needle
- Locate area of great tenderness at greater trochanter
- Insert needle to the bone and pull back slightly , aspirate
- Inject
What are the different types of surgical options for greater trochanteric pain syndrome
Rarely indicated
*only after failure of aggressive conservative treatment
1. Arthroscopic
*debridement of bursae
*greater chance of recurrence
2. Open debridement of bursae
*less chance of recurrence
*increased pain and weakness for longer period of time
