Greater trochanter pain syndrome

Greater trochanteric pain syndrome

 

Definition

 

Chronic lateral trochanteric pain

- abductor tendon tendonitis

- trochanteric bursitis

 

Epidemiology

 

Women 40 - 60 years old

 

Mechanism

 

? repetitive friction of iliotibial tract over GT

 

Symptoms

 

Pain over upper lateral thigh with activity

- often related to hip flexion

 

Examination

 

Localised tenderness & swelling over & posterior to greater trochanterior

 

Pain with resisted abduction

 

DDx

 

Abductor tendon tears

Stress fractures

Intra-articular hip pathology

 

MRI

 

Trochanteric bursitis

Abductor tendinopathy

 

Trochanteric bursitis MRITrochanteric bursitis 2 MRI

Edema around trochanteric bursa on T2 MRI

 

Non operative Management

 

Options

 

Physiotherapy

Shock wave

Cortisone

Platelet rich plasma

 

Shock wave

 

Rompe et al AJSM 2009

- RCT of home training v cortisone v shock wave in 229 patients

- at 4 months shock wave superior to cortisone and home training

- at 15 months, shock wave & home training superior to cortisone

 

Cortisone

 

Wang et al. J Orthop Surg Res 2022

- systematic review

- evidence that cortisone superior to no treatment

- cortisone was not superior to exercises

 

Platelet rich plasma

 

Begkas et al Cureus 2020

- RCT of PRP v cortisone in 24 patients

- superior results for PRP at 6 months

 

Walker-Santiago et al Arthroscopy 2020

- systematic review of PRP versus surgery

- large effect size for PRP with no complications

- moderate to large effect size for surgery with complications including infection, fractures, DVT

 

Operative Management

 

ITB vertical split / cruciform release + trochanteric bursectomy

Arthroscopic technique article

 

ITB release 2ITB release 1ITB release 1

ITB band                                               Longitudinal split

 

ITB release 4ITB release 5

Cruciform release anteriorly                     Bursectomy over abductors

 

Results

 

Drummond et al Arch Orthop Traum Surg 2016

- endoscopic longitudinal ITB release with trochanteric bursectomy

- 49 patients mean age 60

- 20% not satisfied