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
Edema around trochanteric bursa on T2 MRI
Non operative Management
Options
Physiotherapy
Shock wave
Cortisone
Platelet rich plasma
Shock wave
- 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
- 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 band Longitudinal split
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