Greater Trochanteric Pain Syndrome

The current name for what was called “trochanteric bursitis” — the primary pathology is usually insertional tendinopathy of gluteus medius/minimus at the greater trochanter, ± inflammation of the trochanteric bursa, thought to relate to friction from the iliotibial band.

• Demographics: incidence rises with age; classically women >45–50, often after walking programs, tennis or similar “wear and tear” loading.
• History:
  • lateral hip pain, may refer down the leg as far as the foot
  • worse lying on that side at night
  • worse climbing stairs and getting in/out of cars
  • often follows a change in exercise or a strain.
• Examination: localised tenderness over the greater trochanter/outer thigh; hip abductor weakness; ± limp, Trendelenburg gait (“gluteus medius lurch”) or positive Trendelenburg test on the affected side.
• Investigations: clinical diagnosis; ultrasound can confirm bursitis/tendinopathy if needed.
• Management:
  1. NSAIDs (if not contraindicated) + physiotherapy (stretching and progressive gluteal strengthening) — first-line
  2. corticosteroid injection into the bursa if failing
  3. surgery is generally not helpful (causes scarring/shortening of the ITB).

Ischial bursitis

Inflammation of the bursa over the ischial tuberosity: severe buttock pain, especially sitting on a hard chair, with tenderness on/just above the ischial tuberosity. Treat with NSAIDs ± corticosteroid injection.