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TuomoPienimäki

Trochanteric Pain

Essentials

  • Trochanteric pain may be caused by tendopathy or rupture of m. gluteus medius or minimus or by trochanteric bursitis.
  • First-line treatment is conservative.

Aetiology and symptoms

  • The typical patient is a middle-aged or elderly woman. Obesity is a predisposing factor.
  • Over-exertion of the hip as well as microtraumas have aetiological significance. The pain may also be caused by a direct blow injury (falling down) or prolonged exertion, e.g. running.
  • Pain radiating both proximally and distally from the trochanteric area in the hip region and on the lateral aspect of the thigh
  • Pain on walking and on physical strain, e.g. climbing stairs
  • Pain on sleeping on the affected side

Diagnosis

  • Palpation of the greater trochanter indicates the site of tenderness. During the examination the patient lies on his/her side.
  • Extreme abduction of the hip is usually painful, and so is passive extreme adduction and resisted external rotation.
  • Enthesitis or rupture of m. gluteus medius may be a more common cause of trochanteric pain than bursitis. Resisted internal rotation of the hip produces pain laterally in the hip.
  • Referred low back pain, femoral nerve irritation and fibromyalgia should be considered in the differential diagnostics. Burning sensation and pain in the femoral area may be also be caused by meralgia paraesthetica Meralgia Paraesthetica, nerve entrapment in the groin. The symptom of that condition is, however, located distally from the trochanter.

Treatment

  • The first-line treatment is conservative and non-pharmacological. Lateral irritation of the hip is reduced, and any pressure on the area, other burdening factors and physical stress are temporarily avoided.
  • At discretion, the treatment may be complemented by stretching exercises, physiotherapeutic increasing of biobechanical stress endurance, and, as necessary, NSAID medication.
  • Prolonged (4-6 weeks) pain may be treated with an injection of glucocorticoid and local anaesthetic to the most painful site (depth of injection 4-8 cm depending on the thickness of the thigh). The treatment can be considered of relatively low risk. If the first injection does not alleviate pain, the treatment can be repeated after approximately 3-4 weeks. Local glucocorticoid therapy usually has only a short-term effect.
  • There is no convincing evidence on operative treatments.

    References

    • Kong A, Van der Vliet A, Zadow S. MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome. Eur Radiol 2007 Jul;17(7):1772-83. [PubMed]
    • Reid D. The management of greater trochanteric pain syndrome: A systematic literature review. J Orthop 2016;13(1):15-28. [PubMed]
    • Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ 2018;360:k1662 [PubMed]