MedSearchGraphRAG
6 quiz questions available for this topicTake Quiz

Greater trochanteric pain syndrome

SNOMED: 16438211000119101784 words•Updated 03/03/2026
💡

Exam Tips

  • In OSCEs, GTPS is primarily a clinical diagnosis: focal greater trochanter tenderness plus pain on resisted abduction/internal-external rotation is high yield.
  • Pain that rarely goes below the knee supports GTPS over lumbar radiculopathy; true neurological deficits suggest spinal pathology instead.
  • Single-leg stance reproducing lateral hip pain within 30 seconds is a useful bedside discriminator.
  • If there is erythema, warmth, swelling, or systemic upset, pivot to infection workup rather than routine GTPS treatment.
  • Common viva pitfall: calling all cases 'trochanteric bursitis' - explain that gluteal tendinopathy is often the dominant pathology.
  • See Figure: Trendelenburg sign and pelvis drop mechanism (clinical examination figure).

Definition

Greater trochanteric pain syndrome (GTPS) is a regional lateral hip pain syndrome causing chronic intermittent or persistent pain over the greater trochanter, often radiating down the lateral thigh but usually not below the knee. It is now understood as a spectrum of peri-trochanteric soft-tissue disorders (especially gluteus medius/minimus tendinopathy with or without bursal involvement) rather than isolated "trochanteric bursitis".

Pathophysiology

GTPS is usually driven by gluteal tendon pathology (most commonly gluteus medius, then minimus) at or near their insertion on the greater trochanter, with co-existing bursitis in some patients. Repetitive tensile and compressive load across the lateral hip (including iliotibial band friction/compression) causes microtrauma, failed tendon healing, collagen disorganization, and pain sensitization; frank inflammation may be limited or secondary. Biomechanical contributors (hip abductor weakness, altered gait, pelvic control deficits, leg-length discrepancy, obesity) increase tendon compression during single-leg stance. Less commonly, direct trauma, muscle tear, or septic bursitis can produce a similar syndrome.

Risk Factors

  • Female sex, especially age 40-60 years
  • Repetitive loading sports (running, football, dance)
  • Recent change in activity level or overuse
  • Obesity
  • Leg-length discrepancy
  • Iliotibial band tightness/thickening
  • Coexisting lumbar spine disease (degenerative disease or radiculopathy)
  • Hip or ipsilateral knee osteoarthritis
  • Rheumatoid arthritis and fibromyalgia

Clinical Features

Symptoms

  • Gradual-onset lateral hip pain, intermittent or persistent, often chronic
  • Pain over greater trochanter, lateral thigh, or buttock; may radiate down lateral thigh
  • Pain worsened by walking, stairs, prolonged standing, or lying on the affected side
  • Night pain, especially when side-lying on the affected hip
  • Usually no true neurological symptoms; pain rarely extends below the knee

Signs

  • Point tenderness on palpation over greater trochanter/gluteus medius insertion
  • Pain on resisted hip abduction
  • Pain on resisted internal and/or external rotation
  • Positive single-leg stance test (lateral hip pain within 30 seconds)
  • Trendelenburg sign or Trendelenburg gait
  • Possible antalgic gait with shortened stance phase on affected side
  • Possible positive FABER/FADER provoking lateral hip pain
  • Red flags for alternative diagnosis: erythema, warmth, oedema, palpable mass (consider infection)

Investigations

Clinical diagnosis (history and focused neuromusculoskeletal examination):Typical lateral hip pain pattern with focal greater trochanter tenderness and pain on provocative hip tendon-loading tests
Plain X-ray hip/pelvis (if trauma, fracture/dislocation/stress fracture suspected, or diagnostic uncertainty):Usually normal in GTPS; may show alternative pathology such as hip osteoarthritis or fracture
Ultrasound of lateral hip (if persistent symptoms or before injection):May show gluteus medius/minimus tendinopathy, tendon tear, or bursal fluid/thickening
MRI hip (specialist setting for refractory or unclear cases):Defines gluteal tendon tears, peritrochanteric oedema, bursitis, and excludes other intra-articular pathology
Blood tests if infection suspected (FBC, CRP, ESR) and targeted aspiration if septic bursitis concern:Raised inflammatory markers or positive aspirate/culture support septic process

Management

Lifestyle Modifications

  • Relative rest from aggravating activity, then graded return to loading
  • Avoid prolonged side-lying on affected side; use pillow between knees at night
  • Physiotherapy-led hip abductor strengthening, lumbopelvic control, and load-management programme
  • Address biomechanical factors (gait retraining, footwear advice, leg-length correction where appropriate)
  • Weight reduction where relevant
  • Treat coexisting lumbar spine, hip OA, or knee OA contributors
  • See Figure: lateral hip anatomy and gluteal tendon insertions on the greater trochanter (teaching atlas figure)

Pharmacological Treatment

Simple analgesia

  • Paracetamol 1 g orally up to four times daily (max 4 g/day in adults)

Use lowest effective dose; reduce maximum dose in low body weight, frailty, or hepatic impairment.

NSAIDs (oral or topical)

  • Ibuprofen 400 mg orally three times daily with food (max 2.4 g/day prescription dose)
  • Naproxen 250-500 mg orally twice daily
  • Ibuprofen 5% or diclofenac 1% topical gel to painful area up to three to four times daily

Check contraindications: active/previous peptic ulcer, CKD, heart failure, uncontrolled hypertension, NSAID-exacerbated asthma, anticoagulant use, pregnancy (especially 3rd trimester). Consider gastroprotection (for example omeprazole 20 mg once daily) if GI risk.

Local corticosteroid injection (for persistent pain despite conservative care)

  • Methylprednisolone acetate 40 mg peri-trochanteric injection with local anaesthetic
  • Triamcinolone acetonide 40 mg peri-trochanteric injection with local anaesthetic

Use image guidance where available. Do not inject if local/systemic infection or overlying cellulitis. Counsel on transient hyperglycaemia, post-injection flare, skin atrophy/depigmentation, bleeding risk, and rare tendon injury; avoid frequent repeat injections.

Surgical / Interventional

  • Bursectomy for refractory cases
  • Iliotibial band release/lengthening procedures
  • Gluteus medius/minimus tendon repair when significant tear persists despite non-operative management

Complications

  • Chronic pain with sleep disturbance
  • Reduced mobility and functional limitation
  • Abductor weakness and persistent gait disturbance
  • Recurrence or refractory symptoms requiring specialist intervention
  • Medication-related adverse effects (NSAID GI/renal/cardiovascular toxicity; steroid injection adverse events)
  • Rare septic bursitis if infective process present

Prognosis

Overall prognosis is good: more than 90% improve with conservative treatment (load modification, analgesia, physiotherapy, and selective steroid injection). Poorer outcomes are associated with high baseline pain, long symptom duration, widespread pain, greater disability, recurrent episodes, mood disturbance, and maladaptive coping.

Sources & References

✅NICE Guidelines(1)

Sources

Test Your Knowledge

6 quiz questions available for this topic

Start Quiz