Greater Trochanteric Pain Syndrome
Background Info
Greater Trochanteric Pain Syndrome[NR1] (GTPS) is a common cause of lateral hip pain. It is commonly a combination of gluteal tendinopathy and trochanteric bursitis, with the iliotibial band involved.
Two thirds of people with GTPS also have coexisting hip joint osteoarthritis or low back pain (1). Other risk factors for GTPS include obesity, female gender and iliotibial band tenderness.
Subjective Findings
Chronic intermittent lateral hip/buttock/thigh pain
Aggravated with activity and side lying
Recent change in load
Objective Findings
Pain[NR3] on palpation of greater trochanter
Pain during 30 second single leg stance or resisted external rotation tests
Initial Management
Conservative management is the gold standard with over 90% success rate (1)
Activity modification: e.g. reducing amount of time spent sitting with legs crossed and avoiding[NR5] lying on the affected side are effective at reducing symptoms(2)
Weight loss
Dry needling (is as effective as cortisone injections in reducing pain and improving function [NR6] (3))
Isometric exercises for gluteus medius (4)
General exercise including low velocity, high resistance strengthening for the gluteals [NR7] (4)
Failing Conservative Management
Extracorporeal shockwave therapy has been shown to be effective in chronic GTPS, with improvements maintained at 12 months (2)
There is evidence to support the short term benefit of corticosteroid injections on pain (1) however numerous studies on other tendons injuries such as tennis below and achilles tendonopathy show that those who have cortisone injections have worse long term outcomes than those who don’t.
There is a low level of evidence to support surgical interventions including ITB release, bursectomy, trochanteric osteotomy and gluteal tendon repair (1), with no level 1 or 2 evidence in this area.
References
Reid, D. (2016). The management of greater trochanteric pain syndrome: a systematic literature review. Journal of orthopaedics, 13(1), 15-28.
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(1).
Brennan, K. L., Allen, B. C., & Maldonado, Y. M. (2017). Dry needling versus cortisone injection in the treatment of greater trochanteric pain syndrome: a noninferiority randomized clinical trial. journal of orthopaedic & sports physical therapy, 47(4), 232-239.
Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. journal of orthopaedic & sports physical therapy, 45(11), 910-922.
Brooke K Coombes, Leanne Bisset, Prof Bill Vicenzino, (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials[NR8]
[NR1]Use capitals for diagnoses, and anything else when you then provide an abbreviation in capitals
[NR2]I took likely out because it sounds vague. We want to sound definite and confident. The same goes when talking to clients.
[NR3]Don’t use words that aren’t necessary. Extra, un-needed words make an article look longer and more of a hassle to read, and harder to interpret for the reader.
[NR4]This is the opening sentence for all the conservative measures listed below it
[NR5]Use the same tense “reducING” and then “lyING” or it should be “reduce” and then “lie”
[NR6]Whilst more accurate, I don’t think it’s necessary to list the time-frame there. That is apparent in the research it refers to.
[NR7]Again, it’s probably not needed
[NR8]This is an important piece to add. Don’t forget broad information that should provide context to individual cases.