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ANALGESIA

Greater Trochanteric Pain Syndrome: A Review of Anatomy, Diagnosis and Treatment

Bryan S. Williams, MD, MPH^*, and Steven P. Cohen, MD

From the *Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Rush University Medical Center, Chicago, Illinois; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, and Walter Reed, Army Medical Center, Washington, DC.

Address correspondence and reprint requests to Bryan S. Williams, MD, MPH, Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612-3833. Address e-mail to bryan.williams{at}yahoo.com.

Abstract

Greater trochanteric pain syndrome (GTPS) is a term used to describe chronic pain overlying the lateral aspect of the hip. This regional pain syndrome, once described as trochanteric bursitis, often mimics pain generated from other sources, including, but not limited to myofascial pain, degenerative joint disease, and spinal pathology. The incidence of greater trochanteric pain is reported to be approximately 1.8 patients per 1000 per year with the prevalence being higher in women, and patients with coexisting low back pain, osteoarthritis, iliotibial band tenderness, and obesity.

Symptoms of GTPS consist of persistent pain in the lateral hip radiating along the lateral aspect of the thigh to the knee and occasionally below the knee and/or buttock. Physical examination reveals point tenderness in the posterolateral area of the greater trochanter. Most cases of GTPS are self-limited with conservative measures, such as physical therapy, weight loss, nonsteroidal antiinflammatory drugs and behavior modification, providing resolution of symptoms. Other treatment modalities include bursa or lateral hip injections performed with corticosteroid and local anesthetic. More invasive surgical interventions have anecdotally been reported to provide pain relief when conservative treatment modalities fail.