Greater Trochanteric Pain Syndrome

Greater trochanteric pain syndrome (GTPS) is lateral hip pain arising from the structures around the greater trochanter, driven mainly by gluteus medius and minimus tendinopathy.

It replaces the older term 'trochanteric bursitis', because bursitis is usually secondary rather than the main problem. GTPS is the most common cause of lateral hip pain and is most common in women around and after the menopause. It is often mistaken for hip osteoarthritis (OA) or lumbar referred pain, and commonly coexists with both.

Key structures at the greater trochanter:

• •Gluteus medius, the main hip abductor, inserts on the lateral and superoposterior facets. Its tendon is the structure most often affected, which is why GTPS is called the 'rotator cuff of the hip'
• •Gluteus minimus inserts on the anterior facet and is often involved too
• •The iliotibial band (ITB) passes over the trochanter and compresses the tendons against it in hip adduction
• •The trochanteric bursae lie between the trochanter and gluteus maximus and the ITB; bursitis is usually secondary to tendinopathy

GTPS is a compressive tendinopathy. The tendons are compressed against the trochanter in adduction: crossing the legs, lying on the affected side, standing hanging on one hip, single-leg stance, stairs, and running, particularly on cambered surfaces. As at the shoulder, disease runs from reactive tendinopathy to degeneration, with partial or full-thickness tears in some older women.

Risk factors include female sex, age over 40, obesity, a rapid increase in walking or running load, lumbar spine pathology, leg length difference and coexisting hip or knee problems. Declining oestrogen after the menopause may contribute.