Greater Trochanteric Bursitis, or Greater Trochanteric Pain Syndrome (GTPS) are terms used to describe pain and inflammation around the lateral or outside of the hip.
Clinically Relevant Anatomy
A Bursa is a small, fluid filled pouch that acts as a cushion to reduce friction between bone and soft tissues.
The Trochanteric Bursa is the bursa that sits on the outside of the thigh bone (Femur) over the boney area known as the Greater Trochanter. On the outside of the Bursa lies the Iliotibial Band which is a thick band of tissue extending from the pelvis to the shin bone.
What is Trochanteric Bursitis?
Greater Trochanteric Bursitis refers to inflammation of the Bursa over the Greater Trochanter of the Hip Joint. Recent evidence has revealed that inflammation of the Bursa rarely occurs in isolation, and is often accompanied by inflammation of the surrounding tendons (which connect muscle to bone). As such, the term Greater Trochanteric Pain Syndrome (GTPS) is now used to encompass conditions relating to the lateral hip. For the hip joint, this commonly involves tendons of the Gluteus Medius and Gluteus Minimus as seen below.
Common Causes
GTPS can be caused by anything that irritates and places additional stress on the Bursa. This may include:
Repetitive Activities/ Overuse: Completing repetitive activities can cause additional friction and therefore lead to inflammation of the Bursa.
Direct Trauma : Injury involving direct impact onto the outer hip and/or sustained pressure on the outside of the hip associated with trauma.
Posture: Conditions of the spine such as Scoliosis can cause increased rigidity or stiffness and affect the amount of pressure placed on the Bursa.
Other causes may include
- Hip Surgery or Replacement
- Bone Spurs in the Hip
- Infection
- Autoimmune Disease (Rheumatoid Arthritis, Gout, Thyroid Disease, Psoriasis)
Diagnosis
Diagnosis is usually based off a thorough subjective and objective examination. During your assessment, your treating Physiotherapist will ask about your symptoms as well as any activities that bring on your pain. They will also assess your range of motion, hip strength and look for areas of tenderness or pain around the hip.
Imaging is not routinely recommended and is only used to help differentiate between other potential causes. This may include X-Ray or Magnetic Resonance Imaging (MRI) which can be used to rule in or out the presence of other conditions.
Common Signs and Symptoms
- Pain over the outside of the hip, thigh or buttock region
- Pain with side-lying
- Pain worse with weight-bearing on the affected side
- Pain with getting up after remaining seated for prolonged periods
- Pain that worsens with prolonged walking, going up and down stairs or squatting
Management Strategies
Greater Trochanteric Bursitis is commonly managed conservatively with Physiotherapy.
Physiotherapy
Exercise
Exercise is the most common form of management with eccentric exercises (which focus on movements that lengthen the muscle) being more effective than conventional strengthening programs. This is because eccentric exercises can not only help relieve pain, but also promote a normal tendon structure.
Physiotherapy management may comprise of a combination of stretching and strengthening exercises. This may include strengthening the quadriceps and hip abductor muscles as well as stretching the ITB.
In the later stages of rehabilitation, exercises may shift towards improving balance, proprioception and functional alignment to address any underlying muscle imbalances and improve movement patterns.
Education
Education around biomechanics and avoiding aggravating activities can be beneficial in reducing the effect of contributing factors. Activity modification can also play a role in the prevention of future recurrences.
Examples of aggravating activities to avoid may include:
- Prolonged Sitting
- Climbing stairs
- Sleeping on the affected side
- Sitting with crossed legs
- High Impact Exercise
Manual Therapy
Techniques such as massage may be used in the acute stages to help manage pain, ease muscle tension and promote healing.
Alternate strategies such as Therapeutic Ultrasound are not routinely recommended.
Extracorporeal Shock Wave Therapy (ESWT)
ESWT is a non-invasive treatment technology that involves the application of short sound pulses. ESWT can help stimulate the body’s natural healing processes by increasing blood flow and promoting the release of growth factors in the injured tissue.
In individuals with GTPS, the combination of ESWT and exercise therapy has demonstrated a success rate of 86.5% in 2 months.
Adjuncts to Therapy for Pain Relief
During the acute stages, NSAIDs or Corticosteroid Injections may be recommended to help manage pain and inflammation.
Alternatively, heat and/or ice application may be recommended.
- Ice: Can help manage acute inflammation and manage pain. Ice should be applied to the affected area for a maximum of 20 minutes at a time
- Heat: Can help manage pain through reducing muscle tension and easing joint stiffness by increasing blood flow and circulation to the affected area. Heat should be applied for 15- 20 minutes as tolerated.
Prognosis
Recovery from GTPS with conservative management is very favourable. However, treatment times are dependent on individual circumstances and are heavily dependent on adherence to therapy. Although most symptoms may resolve within a few weeks of commencing treatment, management may take up to 3 months or more to fully alleviate symptoms. In individuals with a concurrent diagnosis of hip osteoarthritis, symptoms are 4.8 times more likely to be present 1 year post commencing rehabilitation.
Prevention
Some strategies to avoid the onset of GTPS include the following:
- Maintaining hip strength and flexibility
- Warming up prior to exercise
- Maintain a healthy weight
- Practice good technique and posture
- Avoid repetitive movements and allow for adequate rest/ breaks
- Introduce new activities slowly
For individualised advice, please speak to your treating Physiotherapist.
References
Board, T. N., Hughes, S. J., & Freemont, A. J. (2014). Trochanteric Bursitis: The Last Great Misnomer. HIP International, 24(6), 610–615.
Del Buono, A., Papalia, R., Khanduja, V., Denaro, V., & Maffulli, N. (2012). Management of the greater trochanteric pain syndrome: a systematic review. British medical bulletin, 102, 115–131.
Pumarejo Gomez L, Li DD, Childress JM. Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis) [Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Reid D. (2016). The management of greater trochanteric pain syndrome: A systematic literature review. Journal of orthopaedics, 13(1), 15–28.
Speers, C. J., & Bhogal, G. S. (2017). Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. The British journal of general practice : the journal of the Royal College of General Practitioners, 67(663), 479–480.