Skip to main content

Advertisement

SpringerLink
Log in

Evidenced-Based Management of Greater Trochanteric Pain Syndrome

  • Sports Medicine Rehabilitation (B Liem and BJ Krabak, Section Editors)
  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This paper aims to review the evidenced-based management of greater trochanteric pain syndrome (GTPS).

Recent Findings

There are various studies evaluating greater trochanteric pain syndrome that illustrate the mainstay of treatment is activity modification with the implementation of isometric and isotonic exercise programs. If conservative care fails, short-term benefits can be seen with corticosteroid injections. More refractory cases of GTPS should be referred for diagnostic ultrasound evaluation to illustrate gluteal tendinosis that could benefit from a targeted treatment such as percutaneous tenotomy or orthobiologics.

Summary

GTPS is a common cause of lateral hip pain that typically requires a multimodal diagnostic and therapeutic approach that should be individualized based on patient-centered care. Treatments should take into consideration the individual’s overall health to develop a comprehensive treatment plan that utilizes both conservative and interventional modalities to maximize recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. 2007;88(8):988–92.

    PubMed  PubMed Central  Google Scholar 

  2. Mallow M, Nazarian LN. Greater trochanteric pain syndrome diagnosis and treatment. Phys Med Rehabil Clin N Am. 2014;25(2):279–89.

    PubMed  Google Scholar 

  3. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol. 2013;201(5):1083–6.

    PubMed  Google Scholar 

  4. Saifuddin A, Emanuel R, White J, Renton P, Braithwaite I, Taylor BA. An analysis of radiating pain at lumbar discography. Eur Spine J. 1998;7(5):358–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Strauss EJ, Nho SJ, Kelly BT. Greater trochanteric pain syndrome. Sports Med Arthrosc. 2010;18(2):113–9.

    PubMed  Google Scholar 

  6. Rho M, Camacho-Soto A, Cheng A, Havran M, Morone NE, Rodriguez E, et al. Deconstructing chronic low back pain in the older adult-step by step evidence and expert-based recommendations for evaluation and treatment. Part VIII: lateral hip and thigh pain. Pain Med. 2016;17(7):1249–60.

    PubMed  PubMed Central  Google Scholar 

  7. Tortolani PJ, Carbone JJ, Quartararo LG. Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists. Spine J. 2002;2(4):251–4.

    PubMed  Google Scholar 

  8. Tan LA, Benkli B, Tuchman A, Li XJ, Desai NN, Bottiglieri TS, et al. High prevalence of greater trochanteric pain syndrome among patients presenting to spine clinic for evaluation of degenerative lumbar pathologies. J Clin Neurosci. 2018;53:89–91.

    PubMed  Google Scholar 

  9. Ferrer-Peña R, Moreno-López M, Calvo-Lobo C, López-de-Uralde-Villanueva I, Fernández-Carnero J. Relationship of dynamic balance impairment with pain-related and psychosocial measures in primary care patients with chronic greater trochanteric pain syndrome. Pain Med. 2019;20(4):810–7.

    PubMed  Google Scholar 

  10. Fearon AM, Cook JL, Scarvell JM, Neeman T, Cormick W, Smith PN. Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. J Arthroplast. 2014;29(2):383–6.

    Google Scholar 

  11. Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg. 2009;108(5):1662–70.

    PubMed  Google Scholar 

  12. Bertoti DB, Carcia CR. Pelvis and hip. In: Houglum PA, Bertoti DB, editors. Brunnstrom’s clinical kinesiology, 6e. New York: McGraw-Hill; 2011.

    Google Scholar 

  13. Speers CJ, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. Br J Gen Pract. 2017;67(663):479–80.

    PubMed  PubMed Central  Google Scholar 

  14. Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001;44(9):2138–45.

    CAS  PubMed  Google Scholar 

  15. Walker-Santiago R, Ortiz-Declet V, Maldonado DR, Wojnowski NM, Domb BG. The modified resisted internal rotation test for detection of gluteal tendon tears. Arthrosc Tech. 2019;8(3):e331–4.

    PubMed  PubMed Central  Google Scholar 

  16. Ganderton C, Semciw A, Cook J, Pizzari T. Demystifying the clinical diagnosis of greater trochanteric pain syndrome in women. J Women's Health (Larchmt). 2017;26(6):633–43.

    Google Scholar 

  17. Falvey EC, Franklyn-Miller A, McCrory PR. The greater trochanter triangle; a pathoanatomic approach to the diagnosis of chronic, proximal, lateral, lower limb [corrected] pain in athletes [published correction appears in Br J Sports Med. 2011 Feb;45(2):154]. Br J Sports Med. 2009;43(2):146–52.

    CAS  PubMed  Google Scholar 

  18. Park KD, Lee WY, Lee J, Park MH, Ahn JK, Park Y. Factors associated with the outcome of ultrasound-guided trochanteric bursa injection in greater trochanteric pain syndrome: a retrospective cohort study. Pain Physician. 2016;19(4):E547–57.

    PubMed  Google Scholar 

  19. Shbeeb MI, Matteson EL. Trochanteric bursitis (greater trochanter pain syndrome). Mayo Clin Proc. 1996;71(6):565–9.

    CAS  PubMed  Google Scholar 

  20. Allison K, Vicenzino B, Wrigley TV, Grimaldi A, Hodges PW, Bennell KL. Hip abductor muscle weakness in individuals with gluteal tendinopathy. Med Sci Sports Exerc. 2016;48(3):346–52.

    PubMed  Google Scholar 

  21. Albers S, Zwerver J, Van den Akker-Scheek I. Incidence and prevalence of lower extremity tendinopathy in the general population. Br J Sports Med. 2014;48(Suppl 2):A5.

    Google Scholar 

  22. Birnbaum K, Siebert CH, Pandorf T, Schopphoff E, Prescher A, Niethard FU. Anatomical and biomechanical investigations of the iliotibial tract. Surg Radiol Anat. 2004;26(6):433–46.

    CAS  PubMed  Google Scholar 

  23. • Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther. 2015;45(11):910–22 This describes the important pathoanatomy and pathomechanics involved in gluteal tendinopathy and proposes exercises to utilize for load management and overall recovery.

    PubMed  Google Scholar 

  24. Khoury AN, Brooke K, Helal A, Bishop B, Erickson L, Palmer IJ, et al. Proximal iliotibial band thickness as a cause for recalcitrant greater trochanteric pain syndrome. J Hip Preserv Surg. 2018;5(3):296–300.

    PubMed  PubMed Central  Google Scholar 

  25. Lewis CL, Laudicina NM, Khuu A, Loverro KL. The human pelvis: variation in structure and function during gait. Anat Rec (Hoboken). 2017;300(4):633–42.

    Google Scholar 

  26. Huseynov A, Zollikofer CP, Coudyzer W, et al. Developmental evidence for obstetric adaptation of the human female pelvis. Proc Natl Acad Sci U S A. 2016;113(19):5227–32.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Ganderton C, Pizzari T, Harle T, Cook J, Semciw A. A comparison of gluteus medius, gluteus minimus and tensor facia latae muscle activation during gait in post-menopausal women with and without greater trochanteric pain syndrome. J Electromyogr Kinesiol. 2017;33:39–47.

    PubMed  Google Scholar 

  28. Plinsinga ML, Coombes BK, Mellor R, Vicenzino B. Psychological factors not strength deficits are associated with severity of gluteal tendinopathy: A cross-sectional study. European Journal of Pain. 2018;22(6):1124–1133.

  29. Fearon AM, Ganderton C, Scarvell JM, Smith PN, Neeman T, Nash C, et al. Development and validation of a VISA tendinopathy questionnaire for greater trochanteric pain syndrome, the VISA-G. Man Ther. 2015;20(6):805–13.

    CAS  PubMed  Google Scholar 

  30. French HP, Woodley SJ, Fearon A, O'Connor L, Grimaldi A. Physiotherapy management of greater trochanteric pain syndrome (GTPS): an international survey of current physiotherapy practice. Physiotherapy. 2019;S0031–9406(19)30071–9.

  31. Mallows A, Debenham J, Walker T, Littlewood C. Association of psychological variables and outcome in tendinopathy: a systematic review. Br J Sports Med. 2017;51(9):743–8.

    PubMed  Google Scholar 

  32. Plinsinga ML, Brink MS, Vicenzino B, van Wilgen CP. Evidence of nervous system sensitization in commonly presenting and persistent painful tendinopathies: a systematic review. J Orthop Sports Phys Ther. 2015;45(11):864–75.

    PubMed  Google Scholar 

  33. Steinert L, Zanetti M, Hodler J, Pfirrmann CW, Dora C, Saupe N. Are radiographic trochanteric surface irregularities associated with abductor tendon abnormalities? Radiology. 2010;257(3):754–63.

    PubMed  Google Scholar 

  34. Fearon A, Stephens S, Cook J, Smith PN, Neeman T, Cormick W, et al. The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study. Br J Sports Med. 2012;46(12):888–92.

    PubMed  Google Scholar 

  35. Blankenbaker DG, Ullrick SR, Davis KW, De Smet AA, Haaland B, Fine JP. Correlation of MRI findings with clinical findings of trochanteric pain syndrome. Skelet Radiol. 2008;37(10):903–9.

    Google Scholar 

  36. Coris EE, Pescasio M, Zwygart K, Gonzalez E, Farrar T, Bryan S, et al. Office-based ultrasound in sports medicine practice. Clin J Sport Med. 2011;21(1):57–61.

    PubMed  Google Scholar 

  37. Docking SI, Cook J, Chen S, Scarvell J, Cormick W, Smith P, et al. Identification and differentiation of gluteus medius tendon pathology using ultrasound and magnetic resonance imaging. Musculoskelet Sci Pract. 2019;41:1–5.

    PubMed  Google Scholar 

  38. Ruta S, Quiroz C, Marin J, Catay E, Rosa J, García-Monaco R, et al. Ultrasound evaluation of the greater trochanter pain syndrome: bursitis or tendinopathy? J Clin Rheumatol. 2015;21(2):99–101.

    PubMed  Google Scholar 

  39. Hoffman A, Pfirrmann CWA. The hip abductors at MR imaging. Eur J Radiol. 2012;81:3755–62.

    Google Scholar 

  40. Hoffman DF, Smith J. Sonoanatomy and pathology of the posterior band of the gluteus medius tendon. J Ultrasound Med. 2017;36(2):389–99.

    PubMed  Google Scholar 

  41. Hoffman DF, Sellon JL, Moore BJ, Smith J. Sonoanatomy and pathology of the gluteus minimus tendon. J Ultrasound Med. 2020;39(4):647–57.

    PubMed  Google Scholar 

  42. Cook JL. Purdam CRThe challenge of managing tendinopathy in competing athletes. Br J Sports Med. 2014;48:506–9.

    CAS  PubMed  Google Scholar 

  43. Robinson NA, Spratford W, Welvaert M, Gaida J, Fearon AM. Does dynamic tape change the walking biomechanics of women with greater trochanteric pain syndrome? A blinded randomised controlled crossover trial. Gait Posture. 2019;70:275–83.

    CAS  PubMed  Google Scholar 

  44. Murtaugh B, Ihm JM. Eccentric training for the treatment of tendinopathies. Curr Sports Med Rep. 2013;12(3):175–82.

    PubMed  Google Scholar 

  45. Thompson G, Pearson JF. No attributable effects of PRP on greater trochanteric pain syndrome. New Zealand Med J (Online). 2019;132(1507):22–32.

    Google Scholar 

  46. Clifford C, Paul L, Syme G, Millar NL. Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study. BMJ Open Sport Exerc Med. 2019;5(1):e000558 Published 2019 Sep 21.

    PubMed  PubMed Central  Google Scholar 

  47. Kosek E, Ekholm J, Hansson P. Modulation of pressure pain thresholds during and following isometric contraction in patients with fibromyalgia and in healthy controls. Pain. 1996;64(3):415–23. https://doi.org/10.1016/0304-3959(95)00112-3.

    Article  CAS  PubMed  Google Scholar 

  48. Carlisi E, Cecini M, Di Natali G, Manzoni F, Tinelli C, Lisi C. Focused extracorporeal shock wave therapy for greater trochanteric pain syndrome with gluteal tendinopathy: a randomized controlled trial. Clin Rehabil. 2019;33(4):670–80.

    PubMed  Google Scholar 

  49. Brennan KL, Allen BC, Maldonado YM. Dry needling versus cortisone injection in the treatment of greater trochanteric pain syndrome: a noninferiority randomized clinical trial. J Orthop Sports Phys Ther. 2017;47(4):232–9.

    PubMed  Google Scholar 

  50. Brinks A, van Rijn RM, Willemsen SP, Bohnen AM, Verhaar JA, Koes BW, et al. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care [published correction appears in Ann Fam Med. 2011 Jul-Aug;9(3):371]. Ann Fam Med. 2011;9(3):226–34.

    PubMed  PubMed Central  Google Scholar 

  51. Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med. 2009;37(10):1981–90.

    PubMed  Google Scholar 

  52. • Nissen MJ, Brulhart L, Faundez A, Finckh A, Courvoisier DS, Genevay S. Glucocorticoid injections for greater trochanteric pain syndrome: a randomised double-blind placebo-controlled (GLUTEAL) trial. Clin Rheumatol. 2019;38(3):647–55 This was double-blind randomized placebo-controlled trial that illustrated no greater efficacy of glucocorticoid injections in patients with GTPS.

    PubMed  Google Scholar 

  53. Dean BJ, Franklin SL, Murphy RJ, Javaid MK, Carr AJ. Glucocorticoids induce specific ion-channel-mediated toxicity in human rotator cuff tendon: a mechanism underpinning the ultimately deleterious effect of steroid injection in tendinopathy? Br J Sports Med. 2014;48(22):1620–6.

    PubMed  Google Scholar 

  54. • Mitchell WG, Kettwich SC, Sibbitt WL Jr, et al. Outcomes and cost-effectiveness of ultrasound-guided injection of the trochanteric bursa. Rheumatol Int. 2018;38(3):393–401 This study evaluated the cost-effectiveness of utilizing ultrasound guidance for trochanteric bursa injections and found that ultrasound was likely an unnecessary cost that did not provide significant reduction in patient’s pain levels compared to landmark-guided injections.

    PubMed  Google Scholar 

  55. McEvoy JR, Lee KS, Blankenbaker DG, del Rio AM, Keene JS. Ultrasound-guided corticosteroid injections for treatment of greater trochanteric pain syndrome: greater trochanter bursa versus subgluteus medius bursa. AJR Am J Roentgenol. 2013;201(2):W313–7.

    PubMed  Google Scholar 

  56. Jacobson JA, Rubin J, Yablon CM, Kim SM, Kalume-Brigido M, Parameswaran A. Ultrasound-guided fenestration of tendons about the hip and pelvis: clinical outcomes. J Ultrasound Med. 2015;34(11):2029–35.

    PubMed  Google Scholar 

  57. Chiavaras MM, Jacobson JA. Ultrasound-guided tendon fenestration. Semin Musculoskelet Radiol. 2013;17:85–90.

    PubMed  Google Scholar 

  58. • Jacobson JA, Yablon CM, Henning PT, Kazmers IS, Urquhart A, Hallstrom B, et al. Greater Trochanteric Pain Syndrome. J Ultrasound Med. 2016;35(11):2413–20 This study illustrated significant pain reduction in patients with refractory GTPS who underwent ultrasound-guided tendon fenestration or PRP injections.

    PubMed  Google Scholar 

  59. Fitzpatrick J, Bulsara MK, O’Donnell J, McCrory PR, Zheng MH. The effectiveness of platelet-rich plasma injections in gluteal tendinopathy: a randomized, double-blind controlled trial comparing a single platelet-rich plasma injection with a single corticosteroid injection. Am J Sports Med. 2018;46(4):933–9.

    PubMed  Google Scholar 

  60. • Begkas D, Chatzopoulos ST, Touzopoulos P, Balanika A, Pastroudis A. Ultrasound-guided platelet-rich plasma application versus corticosteroid injections for the treatment of greater trochanteric pain syndrome: a prospective controlled randomized comparative clinical study. Cureus. 2020;12(1):e6583 This study evaluated PRP vs. corticosteroid injections in terms of pain reduction in patients with GTPS and found that patients had longer-lasting pain reduction benefits after PRP injections compared to corticosteroid injections.

    PubMed  PubMed Central  Google Scholar 

  61. Lee JJ, Harrison JR, Boachie-Adjei K, Vargas E, Moley PJ. Platelet-rich plasma injections with needle tenotomy for gluteus medius tendinopathy: a registry study with prospective follow-up. Orthop J Sports Med. 2016;4(11):2325967116671692 Published 2016 Nov 9.

    PubMed  PubMed Central  Google Scholar 

  62. Domb BG, Lindner D, Schwindel L, Stake CE, El Bitar Y. Outcomes of endoscopic treatment for greater trochanteric pain syndrome: minimum of two-year follow-up. Orthop J Sports Med. 2014;2(1 Suppl):2325967114S00012.

    PubMed Central  Google Scholar 

  63. Thomassen PJB, Basso T, Foss OA. Endoscopic treatment of greater trochanteric pain syndrome - a case series of 11 patients. J Orthop Case Rep. 2019;9(1):6–10.

    PubMed  PubMed Central  Google Scholar 

  64. Coulomb R, Essig J, Mares O, Asencio G, Kouyoumdjian P, May O. Clinical results of endoscopic treatment without repair for partial thickness gluteal tears. Orthop Traumatol Surg Res. 2016;102(3):391–5.

    CAS  PubMed  Google Scholar 

  65. Hampton SN, Nakonezny PA, Richard HM, Wells JE. Pain catastrophizing, anxiety, and depression in hip pathology. Bone Joint J. 2019;101-B(7):800–7.

    CAS  PubMed  Google Scholar 

  66. Ferrer-Peña R, Calvo-Lobo C, Aiguadé R, Fernández-Carnero J. Which seems to be worst? Pain severity and quality of life between patients with lateral hip pain and low back pain. Pain Res Manag. 2018;2018:9156247 Published 2018 Oct 22.

    PubMed  PubMed Central  Google Scholar 

  67. de Oliveira BIR, Smith AJ, O’Sullivan PPB, et al. ‘My hip is damaged’: a qualitative investigation of people seeking care for persistent hip pain. Br J Sports Med. 2020:54(14):858–865.

  68. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751–67.

    CAS  PubMed  Google Scholar 

  69. Kanaan Y, Jacobson JA, Jamadar D, Housner J, Caoili EM. Sonographically guided patellar tendon fenestration: prognostic value of preprocedure sonographic findings. J Ultrasound Med. 2013;32(5):771–7.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, NC, 27514, USA

    Michael Boyd, Nevin Vijayaraghavan & Kristopher Karvelas

  2. Department of Orthopedics, University of North Carolina School of Medicine, Chapel Hill, NC, 27514, USA

    Michael Boyd

  3. Memorial Hospital, Campus Box #7200, 101 Manning Drive, Chapel Hill, NC, 27514, USA

    Nevin Vijayaraghavan

Authors
  1. Michael Boyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nevin Vijayaraghavan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kristopher Karvelas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nevin Vijayaraghavan.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article belongs to the Topical Collection on Sports Medicine Rehabilitation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boyd, M., Vijayaraghavan, N. & Karvelas, K. Evidenced-Based Management of Greater Trochanteric Pain Syndrome. Curr Phys Med Rehabil Rep 8, 313–321 (2020). https://doi.org/10.1007/s40141-020-00294-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-020-00294-0

Keywords

Search

Navigation