EpistemisGreater trochanteric pain syndrome
Specialty: Musculoskeletal.
Why it occurs
- Tendinosis or tear of the gluteus medius or minimus tendon
- Trochanteric bursitis (inflammation of the superficial or deep bursa of the trochanter)
- Biomechanical gait alterations (extremity dysmetria, knee osteoarthritis)
- Friction of the iliotibial band on the greater trochanter
- Referred lower lumbar spondylosis with L4-L5 root compression
- Previous hip surgery (total hip arthroplasty)
Initial workup
High-resolution lateral hip ultrasound (assesses distention of the bursa, thickening of the gluteus medius tendon and neovascularization) | AP x-ray of the pelvis and axial hip | Magnetic resonance imaging of the hip in refractory cases.
red flags
Intense lateral pain in the hip that prevents support, associated with high fever, marked local erythema, inability to actively abduct the hip (suspected septic trochanteric bursitis or periarticular septic arthritis).
Standard management
- Meloxicam — 15 mg once daily orally; non-steroidal anti-inflammatory
- Triamcinolone acetonide infiltration — 40 mg with 1% lidocaine in the trochanteric bursa under ultrasound guidance; high short-term effectiveness
- Pregabalin (75 mg orally at night, useful if associated with radiculopathy of lumbar origin).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3