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Greater Trochanteric Pain Syndrome

What is Greater Trochanteric Pain Syndrome?

Greater Trochanteric Pain Syndrome is an inflammatory condition or injury causes paining at the side of the hip or upper portion of the thigh (femur bone), where a certain type of tissues enfold the bony structure. The multiple tissues are enfolded the Greater Trochanteric, such as muscles, tendons, bursae and fascia (strong fibrous tissue).

The alternative term of Greater Trochanteric Pain Syndrome is trochanteric bursitis, as mainly inflammatory condition spread over bursa (plural form of bursae) that enfold the greater trochanter. The structural detail of a bursa can be demonstrated as tiny fluid-filled sacs, which permit frictionless movement between adjoining bony structures.

Therefore, inflammation in the bursa (bursitis)cause painful movement due to the irregular surface of the bones get friction. But Greater Trochanteric Pain Syndrome due to inflammatory conditions of the bursa is only one cause for the development of Greater Trochanteric Pain Syndrome. Any damage or tearing of muscles, tendons, and fascia, which lie over the greater trochanter can be a reason of Greater Trochanteric Pain Syndrome^1,2.

Symptoms

The primary symptom of Greater Trochanteric Pain Syndrome is a recurrent pain at the side of the hip and that spread down to the thigh, knee and less frequently below the knee. Some patients also experience pain below the buttock. The following specificity present in the pain symptom of Greater Trochanteric Pain Syndrome:

During palpation of the affected site cause a virtual feeling of jumping off the bed; for this reason, it has been mentioned in some literature that Greater Trochanteric Pain Syndrome has ‘jump’ sign.
The pain symptom is persistent and will get worse over a time period due to aggravation.
Pain can also worsen at lie down position, especially during night hours and that hampers sleep.
Weightlifting increase pain intensity
Strenuous physical activity like running can aggravate pain symptom
Hip muscle weakness^1,2,3

Causes

Following are some causes which can initiate Greater Trochanteric Pain Syndrome:

- Accidental trauma which directly hit on the affected side of the hip, like falling down from high altitude
- Pressure build up in hip joint due to repetitive movements like walking, cycling etc
- Without guidance taking part in vigorous exercise
- Exercise performing under untrained trainer
- Excessive weight lifting
- Maintain the same posture for Prolong period like standing in a queue^1,2

Diagnosis

The diagnosis of the Greater Trochanteric Pain Syndrome is mainly conducted through physical examination. X-ray is a very common diagnostic test for any skeletal- muscular condition, so in this syndrome also most of the time doctor prescribe for detail identification of the condition. To exclude the possibility of other conditions, MRI or ultrasound may order by some Orthopedicians².

Treatment

Greater Trochanteric Pain Syndrome is a self-limiting condition; it will subside by its own way. But recovery takes time may pain persists for several weeks. Therefore, the following treatment approaches lessen the duration of symptoms persistence. The goals of treatment for Greater Trochanteric Pain Syndrome are pain management, hip strength improvement and get back to normal life and sports activity.

Medication

There are the medications used to treat Greater Trochanteric Pain Syndrome.

Many different types of non-steroidal anti-inflammatory drugs like acetaminophen, ibuprofen, paracetamol are available in the market to decrease the pain and inflammation.
Corticosteroid injections and/or local anesthetic injections in bursa or lateral hip site may require for severe pain, which cannot be controlled by non-steroidal anti-inflammatory drugs.

Physical Therapy

The physical therapy application for the management of Greater Trochanteric Pain Syndrome has three purposes: Pain reduction and protection; Restoration of movement and provide strength; Normalize overall functioning.

PHASE I – Pain Reduction and Protection

Pain is the primary problem in Greater Trochanteric Pain Syndrome; therefore the foremost important criteria to provide physical therapy is to control pain symptom. Following are some techniques applied for symptomatic relief

Ice compression
Relative rest and avoidance of strenuous physical activities.
Some postures of the body also aggravate the pain, such as lengthen the affected hip, leg crossing, hip popping, lying on the side of the affected posture, walking on an uneven surface and hip muscle stretching towards outside.
A variety of physical therapy tools like ice, soft tissue massage, electrotherapy, unloading taping techniques, temporary use of cane or crutch ( an example of mobility aid) is applied to reduce the load on affected side. Some experts also recommend acupuncture for pain relief.

PHASE II – Restoration of movement and provide strength

After pain symptom and associated inflammation are settled, then restoration of hip joint movement and strengthening of affected muscle are next target of treatment.

“Hip Core Stabilisation Program” is developed by physical therapists for regaining of the strength of the affected hip muscle.
Other co-morbidities like osteoarthritis, labral tears need to treat accordingly to obtain effective treatment outcome.

PHASE III – Normalize overall functioning

In this phase treatment plan mainly focus on normalizing the overall functioning and assisting in return to normal life. Depending upon the individual’s need, physiotherapist plan the treatment.

For example, athletes need different therapy to go back to perform the sports, whereas the same treatment plan is not applicable for normal individuals, who do not perform some strenuous physical activity.

Exercises

Physiotherapists recommend some exercise to get an absolute result in the pain reduction and restoration of the normal functioning.

Some exercise techniques assist in to unload the load on the affected side.
After the pain and inflammation reduction, physiotherapist train the affected individual some exercises which will assist in normalizing the range of hip joint and motion by improving muscle strength and endurance, walking pattern, body balancing.
Some exercises also assist in maintaining the pattern, which is important to regulate the muscle firing. The exercise plan differs according to the patient requirement.

Surgical intervention

If above-mentioned treatment plans unable to provide relief from the Greater Trochanteric Pain Syndrome, then anecdotal surgical intervention need to recommend for the affected individual for subsiding the syndrome^2,3,4.

References

Dr Louise Newson, Dr Colin Tidy, (2017); Greater Trochanteric Pain Syndrome; Retrieve from http://patient.info/in/health/greater-trochanteric-pain-syndrome
Jess Clarey, (2017); Greater Trochanteric Pain Syndrome; Retrieve from http://physioworks.com.au/injuries-conditions-1/greater-trochanteric-pain-syndrome
Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg. 2009 May;108(5):1662-70. doi: 10.1213/ane.0b013e31819d6562. Retrieve from https://www.ncbi.nlm.nih.gov/pubmed/19372352
Douglas D Dean, (2017); Trochanteric Bursitis Treatment & Management; Retrieve from http://emedicine.medscape.com/article/309286-treatment#showall