Greater Trochanteric Pain Syndrome

Greater Trochanteric Pain Syndrome is an umbrella term that encompasses a significant number of pathologies associated with lateral-sided hip pain such as trochanteric bursitis, external coxa saltans and abductor tendinopathy.

This debilitating pain is usually experienced by the patient in the greater trochanter, which represents a confluence of three bursae, the hip abductor-lateral thigh muscles and the iliotibial tract.

Previously known only as trochanteric bursitis, the lack of an inflammatory component in the condition has led to the term ‘Greater Trochanteric Pain Syndrome’ as being widely accepted to describe the pain.

In an attempt to further prove this distinction, Tim N. Board from The Centre for Hip Surgery at the Wrightington Hospital recruited twenty-five patients who met the criteria for the diagnosis of trochanteric bursitis.

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A histological analysis of the trochanteric bursal samples obtained from these patients established that not one sample showed evidence of acute or chronic inflammation; the author suggests that any signs of accompanying heat or swelling must be investigated for underlying infection as in the cases of olecranon or patellar bursitis.

While discussing the management of greater trochanteric pain syndrome, Buono et al. reported the predisposing factors for the condition as age, gender, knee osteoarthritis, low back pain and abnormal hip biomechanics.

The authors state that conservative measures such as rest, anti-inflammatory medication, ice and heat, stretching and strengthening, physical therapy, shock wave therapy, ultrasound and local corticosteroid injection are usually effective as the first-line management of greater trochanteric pain syndrome.

However, in order to prevent relapses, it becomes necessary to address the biomechanical discrepancies that can increase the risk of an individual developing lateral-sided hip pain; a hyperpronated foot, for instance, induces excessive medial femoral rotation in the lower extremity leading to changes in the pelvis, spine and sacroiliac joints.

The abnormal hip biomechanics resulting from these changes can be managed with the use of customised orthotics such as MASS4D® that support the foot in its optimal posture to minimise compensatory movements of the lower extremity and to reduce stress on the affected hip.

A comprehensive treatment programme with the inclusion of MASS4D® orthotics as a prophylactic measure prevents recurrences and also protects individuals from developing any other conditions related to the lower extremity.

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References:

1. Board, T. N., Hughes, S. J., Freemont, A. J. (2014) Trochanteric Bursitis: the Last Great Misnomer. Hip International: The Journal of Clinical and Experimental Research on Hip Pathology and Therapy: August 2014, Vol. 24, No. 6, pp. 610-615
2. Buono, A. D., Papalia, R., Khanduja, V., Denaro, V., Maffulli, N. (2012) Management of The Greater Trochanteric Pain Syndrome: A Systematic Review. British Medical Bulletin: 2012, Vol. 102, No. 1, pp. 115-131

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