Understanding Greater Trochanteric Pain Syndrome

Greater Trochanteric Pain Syndrome (GTPS) is a condition often causing discomfort and disability, primarily affecting the hip region. Despite its commonality, it is frequently misunderstood or misdiagnosed. This article aims to provide a comprehensive overview of GTPS, detailing its causes, symptoms, diagnosis, and treatment options.

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What Is Greater Trochanteric Pain Syndrome?

Greater Trochanteric Pain Syndrome is a condition characterized by chronic pain in the lateral aspect of the hip. This area corresponds to the greater trochanter, a bony prominence at the top of the femur. The pain is often due to inflammation of the trochanteric bursa, a fluid-filled sac that reduces friction between the gluteal tendons and the bony structure. However, GTPS can also result from tendinopathy or tears in the gluteal tendons, making it a broader term encompassing various underlying pathologies.

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Causes of Greater Trochanteric Pain Syndrome

Several factors can contribute to the development of GTPS. Understanding these causes is crucial for both prevention and management.

Overuse and Repetitive Stress

One of the primary causes of GTPS is overuse or repetitive stress on the hip joint. Activities that involve excessive walking, running, or standing can lead to microtrauma in the tendons and bursa, eventually resulting in inflammation and pain.

Biomechanical Abnormalities

Abnormalities in biomechanics, such as leg length discrepancies, improper gait, or excessive pronation of the foot, can place undue stress on the hip joint and surrounding structures. These mechanical imbalances can exacerbate the wear and tear on the tendons and bursa, leading to GTPS.

Direct Trauma

Direct trauma to the lateral hip region, such as a fall or bump, can also precipitate GTPS. This trauma can cause immediate inflammation of the bursa or damage to the tendons, resulting in pain and dysfunction.

Other Contributing Factors

Obesity, age, and certain lifestyle factors, such as sedentary behaviour or prolonged sitting, can increase the risk of developing GTPS. Furthermore, the condition is more prevalent in females, possibly due to anatomical differences in pelvic structure and hip mechanics.

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Greater Trochanteric Pain Syndrome Symptoms

The symptoms of GTPS are often insidious in onset and can vary in intensity.

Pain and Tenderness

Patients typically experience pain and tenderness over the lateral aspect of the hip, which may radiate down the thigh or into the buttock. This pain is often exacerbated by activities such as walking, climbing stairs, or lying on the affected side.

Reduced Mobility

GTPS can lead to reduced range of motion in the hip joint, making it difficult for individuals to perform everyday activities. Stiffness and discomfort can also contribute to altered gait patterns.

Swelling and Inflammation

In cases where bursitis is prominent, swelling and warmth over the affected area may be present. However, these symptoms are less common than pain and tenderness.

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Diagnosing Greater Trochanteric Pain Syndrome

Accurate diagnosis of GTPS is essential for effective treatment. This involves a thorough clinical examination and, in some cases, imaging studies.

Clinical Examination

A physical examination is the first step in diagnosing GTPS. The clinician will assess for tenderness over the greater trochanter, evaluate range of motion, and perform specific tests to identify pain patterns associated with the condition.

Imaging Studies

While a clinical examination is often sufficient, imaging studies such as MRI or ultrasound may be utilized to confirm the diagnosis. These modalities can provide detailed views of the soft tissues, identifying inflammation, tendon tears, or other abnormalities.

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Treatment Options for Greater Trochanteric Pain Syndrome

Treatment for GTPS typically involves a combination of conservative measures. In more severe cases, medical interventions may be necessary.

Rest and Activity Modification

Initial management often includes rest and modification of activities that exacerbate symptoms. Patients are advised to avoid prolonged standing, walking, or positions that place stress on the hip joint.

Physical Therapy

Physical therapy is a cornerstone of GTPS treatment. A tailored exercise program can help strengthen the gluteal muscles, improve flexibility, and correct biomechanical abnormalities. Modalities such as ultrasound or shockwave therapy may also be employed to reduce inflammation and promote healing.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs can be effective in managing pain and reducing inflammation associated with GTPS. These medications should be used under the guidance of a healthcare professional.

Corticosteroid Injections

In cases where conservative measures are insufficient, corticosteroid injections into the bursa may provide significant pain relief. These injections can reduce inflammation and allow for improved mobility.

Surgical Options

Surgery is rarely required for GTPS but may be considered in cases of severe tendon tears or persistent symptoms unresponsive to other treatments. Surgical interventions may include bursectomy or tendon repair.

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Greater Trochanteric Pain Syndrome vs. Trochanteric Bursitis

It is essential to differentiate between GTPS and trochanteric bursitis, as the latter is just one component of the former. GTPS is a broader term that encompasses various pathologies affecting the greater trochanteric region, including bursitis, tendinopathy, and tendon tears. Recognizing this distinction is crucial for accurate diagnosis and treatment.