What is greater trochanteric pain syndrome (GTPS)?
GTPS is a common condition causing pain in the lateral aspect of the pelvis. Although commonly called trochanteric bursitis, bursitis on imaging is only present in about 20% of patients. Rather, gluteus medius and minimus tendinopathy, and iliotibial band (ITB) thickening (typically in the region of the entheses of the gluteal muscle insertions), are much more common. Some authors have likened GTPS to rotator cuff tendinopathy in the shoulder, with bursitis involved in a minority of cases and representing a secondary process. Pain is exacerbated by lying on the affected side, walking, climbing stairs, rising from a seated position, and external rotation and abduction of the hip. With significant gluteus medius pathology, the patient may have a positive Trendelenburg test and significant weakness or inability to complete a single repetition of the single-leg mini squat test where the patient squats on the affected leg to 60 degrees.
Initial therapy consists of NSAIDs and physical therapy. ITB tightness may contribute to symptoms in GTPS and can be evaluated by the Ober test ( : History and Physical Examination). ITB stretches and myofascial release through the use of a foam roller may be beneficial. Similarly, physical therapy aimed at stretching and strengthening the gluteus medius and minimus muscles should be considered. Local corticosteroid injection can be helpful in many patients despite the low prevalence of documented bursitis on imaging. Failure to respond to initial therapy may suggest a leg-length discrepancy (leading to gait abnormalities) or gluteus tendon rupture or tear, and evaluations for these conditions should be initiated.