Greater Trochanter
Previously known as “trochanteric bursitis” or “hip bursitis”
Prevalence - In adults aged 50 to 70 is 15% in females and 6% in males
Risk factors - Female, knee pain, lower back pain and obesity
Cause - The tendons of the gluteal muscles become weak, damaged and inflamed
Symptoms - Outside hip pain, worse with walking, prolonged standing, rising from a chair and climbing stairs. Commonly for pain at night rolling onto the affected side. Fatigue from lack of sleep due to pain
Diagnosis - Clinical exam. A hip XRAY can rule out other conditions and a hip ultrasound can confirm
Other diagnoses - GTPS can mimic hip osteoarthritis, fibromyalgia, hip impingement, hip infections, hip fractures, piriformis syndrome, lower back strain, sacroiliac joint problems and nerve pain
Treatment - GTPS is usually a self-limited condition and most people improve within a few months, rarely pain can last one to two years
Step 1) - Pain Relief
Anti-inflammatory medications can be useful if there is acute discomfort and disturbed sleep due to night pain. These can have gastrointestinal and cardiovascular side effects. Options might include:
Ibuprofen (Nurofen) - 400mg to 800mg, up to 3 times per day
Meloxicam (Mobic) - 7.5mg to 15mg per day
Naproxen (Naprosyn) - 250mg, up to 4 times per day
Diclofenac (Voltaren) - 25 to 50mg, up to 4 times per day
Various other therapies have been trialled and may provide short-term relief including:
Topical heat or an ice pack
Topical anti-inflammatories (e.g. Voltaren Gel)
Topical menthol products
Local anaesthetic patches
Step 2) - Activity modification
The following activities can be limited or avoided initially and then gradually reintroduced once the symptoms of GTPS decrease
Minimize stair climbing, walking up hills
Avoid hip adduction across the midline
Sit with hips positioned higher than knees; avoid crossing legs while sitting
Stand with equal weight bearing through lower limbs
Avoid side-lying to reduce compressive tendon load
Step 3) - Corticosteroid Injections
People who are reluctant or unable to take anti-inflammatory medications might consider a local corticosteroid injection around the site of pain instead. One study showed that at 3 months follow-up, 55% of people who had a corticosteroid injection had recovered versus only 34% who took tablet anti-inflammatories. However, at 12 months follow-up, 60% of people in each group had recovered irrespective of which option they took
This usually requires a hip XRAY and hip ultrasound first to confirm, and then a second procedure which is an ultrasound-guided injection. Some GPs or doctors may choose an injection without imaging
Step 4) - Address any contributing conditions
Obesity - Any amount of appropriate weight loss can help
Scoliosis or back pain - Back strengthening exercises can help
Leg length differences > 1cm - An insole or heel lift can help
Hip, knee or foot arthritis
Painful foot disorders such as plantar fasciitis, achilles tendonitis or calluses
Step 5) - Exercises
Everyone should consider seeing a physiotherapist to guide management. Some sample exercises that your physiotherapist might recommend include doing up to 3 sets of 6 to 10 repetitions of the following:
References
GTPS Exercises - RoyalBerkshire
GTPS Exercises - NHS
GTPS Exercises - Sports Medicine
