Standard of Care

From Standard of Care

Characterized by painful inflammation of the bursa located just superficial to the greater trochanter of the femur.

Patients typically complain of lateral hip pain.

The hip joint itself is not involved.

The pain may radiate down the lateral aspect of the thigh.

The term greater trochanteric pain syndrome (GTPS) is now being commonly substituted, because the inflammatory etiology of the pain is being refuted.

Inflammation of the affected bursa between the femoral trochanteric process and the gluteus medius/iliotibial tract may be caused by acute or repetitive trauma.

Acute trauma that can cause trochanteric bursitis may be caused by falls, sports injuries, and other types of impact.

Repetitive trauma includes bursal irritation resulting from friction by the iliotibial band (an extension of the tensor fascia lata muscle) occurs in runners.

Relatively common in physically active patients.

May occur in sedentary individuals.

Unilateral and bilateral greater trochanteric pain syndrome has a prevalence of 15.0% and 8.5% in women, and of 6.6% and 1.9% men, respectively.

Annual incidence in primary care reported as being 1.8 patients per 1000.

Associated with chronic pain, limping and difficulty with sleeping.

Female:male 80%:20%.

Can occur at any age.

Lateral hip pain is the classic presentation.

Pain increased by lying down on the affected bursa and is exacerbated by walking, running and weight bearing with internal and external hip rotation.

The patient may be report weakness of the leg due to pain.

Classically point tenderness is present over the greater trochanter, reproducing symptoms.

Lateral hip pain can often be elicited by passive external rotation of the hip.

Lateral hip pain can be reproduced with flexion of the hip.

Differential diagnosis: Osteoarthritis, fracture of the femur, avascular necrosis of the femoral head, lumbosacral radiculopathy, gluteus medius bursitis,glucose medius partial tear, iliopsoas bursitis, and iliotibial band tenditis.

Diagnosis is clinically based and radiographic imaging may be performed to rule out other entities.

Injection of local anesthetic into the trochanteric bursa may be helpful in confirming the diagnosis.

Corticosteroid and lidocaine injections into the bursa is an effective therapy with a prolonged benefit.

Physical therapy, NSAIDs are often employed in management.