Greater Trochanteric Pain Syndrome
What is Greater Trochanteric Pain Syndrome?
Greater Trochanteric Pain Syndrome (GTPS) is a medical condition that causes pain in the outer part of the hip, specifically the greater trochanter area of the femur (thigh bone). The term 'Trochanteric Bursitis' was previously used to describe this condition, but it is now understood to involve more than just bursitis, including tendinopathy and muscle tears. GTPS predominantly affects middle-aged women and can significantly impact mobility and quality of life.
Causes of GTPS
Several factors can contribute to the development of GTPS, including:
- Overuse Injuries: Repetitive motion or prolonged pressure on the hip area can lead to tendon and bursa inflammation.
- Muscle Imbalances: Weakness or tightness in the hip muscles can alter normal gait and add stress to the tendon attachments.
- Trauma: A direct blow to the hip or falling on the hip can result in inflammation.
- Biomechanical Issues: Abnormalities in the way you walk or run can predispose you to GTPS.
Symptoms of GTPS
People with GTPS typically experience the following symptoms:
- Pain: Persistent pain on the outside of the hip, which may radiate down the outside of the thigh.
- Tenderness: Tenderness around the greater trochanter when pressing on the hip.
- Swelling: Possible swelling or warmth over the lateral hip region.
- Pain at Night: Pain may worsen at night or when lying on the affected side.
- Limited Range of Motion: Difficulty or discomfort with movements such as walking, climbing stairs, or sitting cross-legged.
Diagnosis
Diagnosing GTPS typically involves a thorough clinical evaluation by a healthcare provider. They may review your medical history, perform a physical examination focusing on the hip area, and assess your gait. Additionally, imaging studies such as X-rays, ultrasound, or MRI may be requested to rule out other conditions and confirm the diagnosis.
Treatment Options
GTPS is usually manageable with a combination of the following treatments:
- Rest and Activity Modification: Avoiding activities that exacerbate symptoms and allowing time for healing.
- Physical Therapy: A focused exercise programme to strengthen hip muscles, improve flexibility, and correct biomechanical issues.
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce pain and inflammation.
- Injections: Corticosteroid injections can provide temporary relief from pain and inflammation.
- Extracorporeal Shock Wave Therapy (ESWT): A non-invasive treatment using shock waves to promote healing.
- Surgery: Rarely needed, but may be considered in severe or refractory cases.
Prevention
To prevent GTPS, consider adopting the following lifestyle modifications:
- Maintain a Healthy Weight: Reducing excess weight can lessen the stress on your hips.
- Exercise Regularly: Engage in a balanced exercise routine that includes strength training, stretching, and aerobic activities.
- Proper Footwear: Wear supportive shoes that align well with your gait and activity levels.
- Avoid Overuse: Gradually increase activity intensity and duration to avoid overstressing your hip muscles.
- Good Posture: Maintain proper posture during activities to ensure even distribution of body weight.
Frequently Asked Questions
What is Greater Trochanteric Pain Syndrome (GTPS)?
Greater Trochanteric Pain Syndrome (GTPS) is a condition characterized by pain and tenderness on the outer side of the hip, usually related to inflammation or injury to the muscles, tendons, or bursae in the area.
What are the common symptoms of GTPS?
Common symptoms include pain on the outside of the hip and thigh, tenderness over the greater trochanter, discomfort when lying on the affected side, and pain that worsens with activity such as walking or climbing stairs.
What causes GTPS?
GTPS can be caused by overuse or repetitive activities, trauma to the hip, muscle tears, tendon degeneration, or bursitis. It is also sometimes associated with conditions such as iliotibial band syndrome or osteoarthritis.
Who is at risk for developing GTPS?
People at risk include those who engage in repetitive hip movements, runners, individuals with a high body mass index (BMI), women, and those aged between 40 and 60 years.
How is GTPS diagnosed?
A GP or specialist typically diagnoses GTPS through a physical examination, patient history, and sometimes imaging tests such as ultrasound or MRI to rule out other conditions.
What are the initial treatments for GTPS?
Initial treatments often include rest, ice application, anti-inflammatory medications, and physical therapy aimed at strengthening and stretching the hip muscles.
Are there specific exercises that help with GTPS?
Yes, exercises that focus on strengthening the hip abductors, such as side leg lifts, and stretching the iliotibial band can be beneficial. A physiotherapist can provide a tailored exercise programme.
Can I still exercise if I have GTPS?
Yes, but it's important to modify activities to avoid those that exacerbate pain. Low-impact activities like swimming or cycling may be more suitable while the condition heals.
How long does it take for GTPS to heal?
The recovery time can vary, but with proper treatment, many people start to see improvement within a few weeks to a few months. Persistent cases may take longer to resolve.
Is surgery ever required for GTPS?
Surgery is rarely needed for GTPS and is typically considered only when conservative treatments fail over a long period. Surgery might involve tendon repair or bursectomy.
Can GTPS recur after treatment?
Yes, GTPS can recur, especially if the underlying causes are not addressed. Maintaining strong and flexible hip muscles, and avoiding repetitive hip strain, can help prevent recurrence.
Are there any lifestyle changes that can help manage GTPS?
Yes, maintaining a healthy weight, practicing good posture, using ergonomically designed furniture, and avoiding activities that strain the hip can help manage and prevent GTPS.
Can GTPS be prevented?
While not all cases can be prevented, reducing risk factors such as avoiding repetitive hip movements and maintaining proper hip strength and flexibility can reduce the likelihood of developing GTPS.
Is GTPS related to hip arthritis?
GTPS can coexist with hip arthritis but they are distinct conditions. Hip arthritis involves joint degeneration while GTPS involves inflammation or injury to the surrounding tendons or bursae.
Should I see a specialist for GTPS?
If initial treatments by a GP do not improve symptoms, or if the pain is severe, seeing a specialist such as an orthopaedic surgeon or a physiotherapist may be beneficial for further management.
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