Skip to content

Greater Trochanteric Pain Syndrome (GTPS)

(formerly known as Trochanteric Bursitis)

BASICS

  • Definition: Lateral hip pain associated with bursitis, gluteal tendinopathy, and external snapping hip.
  • Anatomy:
  • Involves subgluteus maximus bursa, gluteus medius/minimus tendons, iliotibial band (ITB), tensor fascia latae, and other adjacent structures.
  • Terminology:
  • GTPS preferred over “trochanteric bursitis” due to the multifactorial nature of pathology (bursal, tendon, enthesis).

EPIDEMIOLOGY

Metric Value
Incidence 1.8 per 1,000/year
Peak age 40–60 years
Sex Female > Male
Population Runners, contact sports (football, rugby, soccer)

ETIOLOGY & PATHOPHYSIOLOGY

Acute:

  • Abnormal gait
  • Tendon overuse
  • Direct trauma (e.g., lying on the affected side)

Chronic:

  • Fibrosis and bursal thickening
  • Tendinopathy (esp. gluteus medius/minimus)

Note: No known genetic predisposition

RISK FACTORS

  • Female sex
  • Obesity
  • Tight hip/ITB musculature
  • Leg length discrepancy
  • SI joint dysfunction
  • Hip/knee OA
  • Pes planus, overpronation
  • Trendelenburg gait
  • Post-THA (total hip arthroplasty)

ASSOCIATED CONDITIONS

  • Low back pain
  • Hip and knee OA
  • Neuromuscular abnormalities
  • Abnormal pelvic/femoral architecture

CLINICAL PRESENTATION

History

  • Lateral hip or buttock pain ± radiating to lateral thigh (“pseudoradiculopathy”)
  • Exacerbated by:
  • Walking, standing
  • Rising from sitting
  • Lying on affected side
  • Crossing legs

Physical Exam

Finding Comment
Point tenderness over greater trochanter Most sensitive
Pain with resisted abduction/rotation Supportive
Trendelenburg sign Indicates gluteal weakness
Ober test For ITB tightness
FABERE Rule out hip OA/SI pathology
Neurological exam Rule out lumbosacral radiculopathy
Leg length, gait, foot mechanics Evaluate contributing biomechanics

DIFFERENTIAL DIAGNOSIS

  • ITB syndrome
  • Piriformis syndrome
  • Hip OA or AVN
  • Lumbosacral disc disease
  • Femoral neck stress fracture (esp. female runners)
  • Septic bursitis
  • Hip or pelvic fracture

DIAGNOSTIC TESTING

Labs:

  • Not routinely needed unless infection suspected

Imaging:

Modality Indication
Ultrasound Aspiration, injection guidance
X-ray (AP/frog-leg) Rule out fracture, arthritis
MRI Recalcitrant pain, rule out stress fracture
Spine X-ray Back pain symptoms

MRI findings often nonspecific; poor correlation with GTPS symptoms.

TREATMENT

GENERAL MEASURES

  • Physical therapy:
  • Hip abductors/gluteal strengthening
  • ITB stretching
  • Gait retraining
  • Aquatic therapy
  • Activity modification:
  • Reduce running intensity/distance
  • Avoid lying on affected side
  • Weight loss, if indicated

MEDICATION

Medication Dosage
Naproxen 500 mg PO BID
Ibuprofen 800 mg PO TID
  • Duration: 2–4 weeks

Corticosteroid Injection

  • Agents: Kenalog 40 mg/mL or Dexamethasone 4 mg/mL
  • Dose: 1–2 mL ± local anesthetic
  • Repeatable with caution
  • May be less effective in chronic tendinopathy

Goal: short-term pain relief to facilitate PT

ADDITIONAL THERAPIES

  • Ice packs
  • Shockwave therapy (low-energy)
  • Heel lift (if leg length discrepancy)
  • Orthotics (for overpronation)

Alternative/Adjunct Options

  • Acupuncture
  • Platelet-rich plasma (PRP)
  • Prolotherapy
  • Growth factor injections

REFERRAL & SURGERY

Indication Referral
Septic bursitis Immediate referral
Suspected gluteal tendon tear Orthopedic consultation
Refractory GTPS Surgical options

Surgical Procedures

  • Arthroscopic bursectomy
  • ITB release
  • Gluteus medius tendon repair
  • Tenotomy

FOLLOW-UP & PATIENT EDUCATION

  • Follow-up: 4 weeks post-treatment or earlier if worsening
  • Educate on:
  • Modifiable risk factors
  • Corrective footwear
  • Gradual return to activity
  • Postural/muscle balance

PROGNOSIS

  • Acute cases: Excellent prognosis
  • Chronic/recurrent cases: Variable outcomes, prolonged recovery possible

COMPLICATIONS

  • Bursal fibrosis
  • Referred lumbar or gluteal pain
  • Underdiagnosed gluteal tendon tear
  • Misdiagnosed stress fractures (femoral neck!)

CODES

ICD-10 Description
M70.60 Trochanteric bursitis, unspecified
M70.61 Right hip
M70.62 Left hip

CLINICAL PEARLS

  • GTPS = Not just bursitis → Gluteal tendinopathy often the main pain source
  • Femoral neck stress fractures must be excluded in female runners with lateral hip pain
  • Corticosteroid injections helpful short-term, but PT is the mainstay
  • Don't forget to assess gait mechanics, leg length, and lumbar spine