Greater trochanteric pain syndrome (aka tronchanetric bursitis)

Question 1

Describe what is meant by greater trochanteric pain syndrome (GTPS)

Answer 1

Trochanteric bursitis refers to inflammation of a bursa over the greater trochanter on the outer hip.

Bursae are sacs created by synovial membrane filled with a small amount of synovial fluid.

Question 2

Describe the pathophysiology of greater trochanteric pain syndrome [3]

Answer 2

GTPS is associated with damage to the tendons of the gluteus medius and/or minimus muscles +/- inflammation of the trochanteric bursa.

This damage is thought to be caused by:
- compression by the iliotibial band on the gluteal muscle tendons and trochanteric bursa as the hip is adducted.

This compression is contributed to by:
* Weakness of the abductor muscles of the hip
* Causing lateral pelvic tilt.

Question 3

What are the causes of trochanetric bursitis? [4]

Answer 3

• Friction from repetitive movements
• Trauma
• Inflammatory conditions (e.g., rheumatoid arthritis)
• Infection – referred to as septic bursitis

Question 4

Describe the clinical presentation associated with trochanteric bursitis [5]

Answer 4

• Gradual onset lateral hip pain (over the greater trochanter) - may radiate down the outer thigh
• Pain is aching or burning sensation
• Worse with activity, standing after sitting for a prolonged period of time
• Pain may disrupt sleep
• Positive trendelenburg gait
• Pain on movement of hip in directions that cause increased tension of the gluteus medius and minimus tendons- i.e. FABER test (flexion, abduction, and external rotation), FADER test (flexion, adduction, and external rotation), and ADD test (passive hip adduction)

Question 5

Which special tests would you use to establish a diagnosis of trochanteric bursitis? [4]

Answer 5

Trendelenburg test
Resisted abduction of the hip
Resisted internal rotation of the hip
Resisted external rotation of the hip

Question 6

What are the management options for trochanteric bursitis? [4]

Answer 6

• Rest
• Analgesia
• Physiotherapy
• Peri-trochanteric corticosteroid injection
• • Generally reserved for cases where other conservative treatment modalities have failed, or in the short-term to enable physiotherapy (which has been shown to improve the long-term outlook).
• • Evidence of short-term benefit - up to three months, with the most significant effect seen at six weeks.
• Surgical intervention is reserved for the small portion of cases in which conservative management is unsuccessful.