Greater Trochanteric Pain Syndrome Management and Diagnosis

Greater Trochanteric Pain Syndrome (GTPS) encompasses a spectrum of disorders affecting the lateral hip region, most commonly gluteal tendinopathy and trochanteric bursitis. It predominantly affects middle-aged to older adults, especially women, and manifests as lateral hip pain exacerbated by weight bearing, ambulation or lying on the affected side. Diagnosis relies on a detailed clinical assessment including palpation over the greater trochanter, pain provocation tests and exclusion of intra-articular pathology. Imaging such as ultrasound and magnetic resonance imaging can confirm gluteal tendon degeneration, tears or bursal inflammation and guide management. Initial treatment is conservative, centring on load modification, tailored exercise programmes and anti-inflammatory interventions. Injectable therapies—including corticosteroids and platelet-rich plasma—are employed for refractory cases, while extracorporeal shockwave therapy may offer additional benefit. Surgical options, ranging from minimally invasive endoscopic repair to augmented tendon reconstruction, are reserved for persistent symptoms or structural tendon defects. Restoration of hip biomechanics, particularly after hip arthroplasty, is critical to prevent or ameliorate GTPS. A multidisciplinary approach integrating physiotherapy, image-guided interventions and, where necessary, surgical repair, underpins optimal patient outcomes and functional restoration.

Research from Nature Portfolio

Recent systematic reviews of exercise-based interventions have demonstrated that targeted loading programmes yield significant short- and long-term functional improvements in gluteal tendinopathy, outperforming minimal interventions and offering similar pain relief to corticosteroid injections. The certainty of evidence, however, remains low to very low, highlighting the need for large, high-quality randomised trials. Foundational biomechanical analyses following total hip arthroplasty have clarified that precise restoration of leg length and combined femoral-acetabular offset within 5 mm of the contralateral hip is associated with a substantially reduced incidence of trochanteric pain and superior patient-reported outcomes at three years post-surgery.

Greater Trochanteric Pain Syndrome Management and Diagnosis publication trend

The graph below shows the total number of articles in greater trochanteric pain syndrome management and diagnosis across all publications each year (not limited to Nature Index journals).

Technical terms

Greater Trochanteric Pain Syndrome (GTPS): A clinical entity characterised by lateral hip pain due to gluteal tendon pathology and associated bursal inflammation.

Gluteal tendinopathy: Degenerative or overload injury of the gluteus medius or minimus tendons adjacent to the greater trochanter.

Trochanteric bursitis: Inflammation of the bursa over the greater trochanter, contributing to lateral hip pain.

Platelet-rich plasma (PRP): Autologous plasma fraction concentrated with platelets, used to enhance tissue healing.

Corticosteroid injection (CSI): Local administration of steroid medication to reduce inflammation in tendons or bursae.

Isometric exercise: Muscle activation without joint movement, maintaining constant muscle length under load.

Isotonic exercise: Muscle activation with dynamic joint movement under constant resistance.

References

1. Good clinical outcomes, a high level of patient satisfaction and an acceptable re‐operation rate are observed 7–10 years after augmented hip abductor tendon repair. Knee Surgery, Sports Traumatology, Arthroscopy (2023).
2. Effects of exercise-based interventions on gluteal tendinopathy. Systematic review with meta-analysis. Scientific Reports (2024).
3. Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty. Scientific Reports (2020).
4. Ultrasound-guided Platelet-rich Plasma Application Versus Corticosteroid Injections for the Treatment of Greater Trochanteric Pain Syndrome: A Prospective Controlled Randomized Comparative Clinical Study. Cureus (2020).
5. Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study. BMJ Open Sport & Exercise Medicine (2019).
6. Long-term outcome of low-energy extracorporeal shockwave therapy on gluteal tendinopathy documented by magnetic resonance imaging. PLOS ONE (2018).