PART 1; Greater Trochanteric Pain Syndrome (that annoying pain on the side of your hip)

Do you have localised pain around the outer part of your hip? Is it tender when you press on it? Has it started as dull ache but now it progressed as being more sharp? Are you having troubles putting on socks, getting out of the car, or lying on that side? The pain could also be extending down the lateral thigh and upper leg. Have you recently increased your activity as in like starting high-intensity training, jumping from side to side, running or doing anything that puts pressure on the side of your hips? If this sounds like you, keep reading.

But before we dive deeper, this series on Greater Trochanteric Pain Syndrome (GTPS) will be broken down into 4 parts. Each article will cover key aspects of the condition, starting with the likely causes of your pain, followed by common risk factors, differential diagnoses (what other conditions could be contributing/causing it), the role of imaging, and finally treatment options and management strategies.

Basic anatomy intro

The greater trochanter (hence the name) is a bony point located on the lateral (outer) part of your hip. Surrounding it, you have lots of structures including multiple bursae, which are basically these ‘fluid filled sacs’ that reduce friction between tendons, bones and other structures. Of particular importance here are the gluteus minimus and gluteus medius muscles and their tendons which attach to the greater trochanter.

Causes?

We used to think that the primary cause of GTPS was inflammation of the bursa surrounding the greater trochanter (trochanteric bursitis). However, we now know that isolated bursitis is not so common. Instead, it’s mostly these tendons that get overstressed and overloaded with bursa getting irritated in some cases as a result. There can also be some cases where muscle & tendon tears and calcification are present.

For example…This cross-sectional study that formed part of a large prospective cohort study included 132 patients with lateral hip pain referred for MRI. 94% were women with median age 54 years (range: 18-77 years). They found that only 2% of participants had isolated trochanteric bursitis with no associated gluteal tendinopathy, 25% had gluteal tendinopathy with some inflammation in the GT bursa, 4% had tendinopathy with bursitis in the subgluteus minimus bursa with no GT bursa and 4% had calcifications lateral to the GT on X-ray.

Another study included 877 patients and fount that only 8% had bursitis in isolation, while 41% had gluteal tendinopathy in isolation, which makes it way more prevalent. When combined together, 20% of people had GT bursitis and 50% had some signs of gluteal tendinopathy. What was interesting is that they found ITB abnormalities like tears or thickening in 30% of people.

Now, there were some limitations in the studies, such as interpreting the findings or comparing them to other imaging techniques or methods. Additionally, structural changes don’t always directly correlate with pain (I'll explain this further in part 3). However, the key takeaway is that bursitis rarely occurs on its own. And as the name suggests, due to the structural complexity of the lateral hip with multiple muscles, bursae, tendons, and other tissues interacting around the greater trochanter, many of these structures could currently be making your hip a bit unhappy, which is why we use the broader term "GTPS."

What's Next?

In the next article, I will discuss who could be at risk of getting this issue (prevalence and risk factors).