Greater Trochanteric Pain Syndrome
Orthopedics
Illness script · Orthopedics
Greater Trochanteric Pain Syndrome
Lateral hip pain arising from gluteal tendinopathy and/or trochanteric bursitis at the greater trochanter, formerly called trochanteric bursitis.
This illness script for Greater Trochanteric Pain Syndrome covers predisposing factors, classic presentation, mechanism, workup, management, and the clinical pivots that separate it from look-alikes—written for USMLE Step 1 and clerkship reasoning.
01
Predisposing factors
- Middle-aged women most affected (peak 40–60 yrs); female-to-male ratio ~4:1
- Obesity and increased BMI elevate compressive load on tendons
- Iliotibial band tightness — major compressive contributor
- Runners and overuse athletes; rapid mileage increases
- Leg length discrepancy alters hip abductor biomechanics
- Concurrent low back pain or hip osteoarthritis common
02
Presentation
- Lateral hip pain, point-tender directly over greater trochanter on palpation
- Pain worst lying on affected side at night or sitting cross-legged
- Worsened by stairs, prolonged walking, running
- Positive FABER test reproducing lateral (not groin) pain
- Resisted hip abduction reproduces pain; possible Trendelenburg sign
- No groin pain and preserved internal rotation (distinguishes from intra-articular disease)
03
Pathophysiology
- Primarily gluteus medius/minimus tendinopathy from compressive and tensile overload at greater trochanter insertion
- IT band compresses tendons against trochanter during adduction (e.g., crossing legs, lying on side)
- Trochanteric bursal inflammation can coexist but is rarely the sole cause
- Tendon degeneration (not classic inflammation) underpins chronic cases — key therapeutic implication
04
Diagnostics
- Clinical diagnosis: lateral trochanteric tenderness + characteristic history sufficient
- MRI: gold standard — shows gluteal tendon signal change, partial/full tears, bursitis
- Ultrasound: confirms tendinopathy, bursitis, and guides injection in real time
- X-ray: usually normal; may show calcific tendinopathy or exclude bony pathology
- Pearl: do NOT miss a full-thickness gluteal tendon tear on MRI — changes management significantly
05
Management
- First-line: load management, activity modification, avoid compressive postures (crossing legs, hip adduction)
- Physical therapy focused on hip abductor strengthening and IT band flexibility
- NSAIDs for short-term pain relief
- Corticosteroid injection: rapid symptom relief but risks tendon weakening with repeated injections
- PRP injection or surgical tendon repair for refractory or complete gluteal tendon tears
06
Clinical pivots
How to separate this script from the look-alikes that show up on exams and on the wards.
Hip osteoarthritis
OA pain localizes to the groin and is reproduced by passive internal rotation, not trochanteric palpation.
Meralgia paresthetica
Meralgia causes anterolateral thigh burning/numbness from lateral femoral cutaneous nerve compression, not point tenderness over the trochanter.
Lumbar radiculopathy (L4–L5)
Radiculopathy follows a dermatomal pattern with back involvement and neurologic deficits; trochanteric tenderness is absent.
Snapping hip syndrome (coxa saltans)
Coxa saltans produces an audible or palpable snap over the trochanter with hip flexion/extension rather than consistent lateral pain.
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Educational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.