Lateral hip pain over the greater trochanter, now understood mostly as gluteal (medius/minimus) tendinopathy ± bursal involvement. Driven by compressive load and abductor weakness. Reduce compression, load progressively.

_Greater Trochanteric Pain Syndrome (GTPS)_

Summary

Pathology. GTPS is most often a gluteal (medius/minimus) tendinopathy at the greater trochanter, sometimes with bursal involvement, driven by compressive load (hip adduction — crossing legs, side-lying, standing 'hanging' on the hip) and abductor weakness. Management reduces compression, avoids provocative positions and progressively loads the hip abductors.

Clinical presentation (signs & symptoms)

Lateral hip pain over the greater trochanter, worse lying on the side (disturbed sleep), stairs and prolonged standing; may radiate down the lateral thigh; local tenderness on palpation.

Assessment (Examination & Assessment)

Subjective

Lateral hip pain over the greater trochanter; worse lying on the affected side (night), climbing stairs, prolonged standing/walking; may radiate down the lateral thigh. (Now understood largely as gluteal tendinopathy ± bursa.) Pain scale.

Objective

Palpation over the greater trochanter (tenderness — key finding); single-leg stance test (30 s reproduces pain); resisted hip abduction; FABER; Trendelenburg; Ober's.

Differentiate from

Hip OA, lumbar referral, ITB syndrome, L5/S1 radicular pain.

Key special tests

| Test | What a positive result indicates | |---|---| | Greater trochanter palpation | local tenderness (primary finding) | | Single-leg stance test (30 s) | reproduces lateral hip pain | | Resisted hip abduction | pain and/or weakness | | Trendelenburg test | abductor function | | FABER / Ober's | differentiation from hip joint / ITB |

Red flags & when to refer

Hip osteoarthritis (groin pain, restricted internal rotation)
Lumbar referral / L5 radiculopathy
Gluteal tendon tear (marked abductor weakness)

Contraindications & precautions

Avoid ITB/adduction stretches that compress the tendon against the trochanter (worsen symptoms).
Dry needling: control depth (sciatic nerve lies posteriorly); infection, anticoagulants, needle phobia; consent & hygiene.
Rule out hip OA and lumbar referral — refer if suspected.

Treatment protocol

Session structure & time scales

Pre-assessment + prep (10 min): palpation, single-leg stance, resisted abduction.
Soft tissue — glutes, TFL/ITB (12–15 min).
Hip mobilisations (5 min).
Dry needling — glute-med/min trigger points (8 min).
Electrotherapy — US (8 min).
Glute-abductor isometric loading demo (5–8 min).
Reassessment + home programme (5 min).

Modalities & rationale

| Modality / technique | Rationale (why it is used for this pathology) | |---|---| | Soft tissue (glutes/TFL) | reduces peritrochanteric tension and sensitivity. | | Hip mobilisations | address contributing stiffness and mechanics (Banks, 2013). | | Dry needling (glute-med/min) | relieves gluteal trigger points contributing to pain (Sharkey, 2017). | | Therapeutic ultrasound | parameter-dependent symptom support (Watson, 2008). | | Isometric → progressive glute-abductor loading | the evidence-based driver for gluteal tendinopathy; avoid provocative ITB compression. |

Loading & exercise progression

Isometric → progressive hip-abductor loading. Avoid compressive positions (adduction, side-lying on the affected side, 'hanging' on one hip); sleep-posture advice.

Home care / self-management

Isometric then progressive glute-abductor loading, avoid provocative positions (crossing legs, standing on one hip), sleep posture (pillow between knees, avoid lying on affected side), load management.

Outcome measures & re-assessment

Pain scale (NPRS 0–10) pre/post; night/side-lying pain over sessions.
Repeat single-leg stance test & greater-trochanter palpation.
Reassess resisted hip abduction strength.
Function: stairs & standing tolerance.

Anatomy reference

| Structure | Origin | Insertion | Action | |---|---|---|---| | Gluteus medius | ilium between anterior & posterior gluteal lines | lateral & superoposterior greater trochanter | hip abduction; pelvic stabilisation | | Gluteus minimus | ilium between anterior & inferior gluteal lines | anterior facet of greater trochanter | abduction, internal rotation; stabilisation | | Tensor fasciae latae (TFL) | ASIS & anterior iliac crest | ITB → Gerdy's tubercle | hip flexion, abduction, internal rotation | | Trochanteric bursa | deep to ITB/glute max, over greater trochanter | — | — reduces friction (may be involved) |

Clinical reasoning (Q&A for the system)

_These question–answer pairs encode the expected clinical reasoning for this condition. Use them to justify decisions and to check generated plans._

Q: What is the current understanding of 'trochanteric bursitis'? A: GTPS is now understood as mostly a gluteal (medius/minimus) tendinopathy at the greater trochanter, sometimes with bursal involvement — not a pure bursitis.

Q: What test and symptom point to GTPS? A: Lateral hip pain over the greater trochanter, worse lying on that side, on stairs and with prolonged standing; the single-leg stance test (30 s) and local palpation reproduce it.

Q: Why avoid ITB/adduction stretches here? A: Adduction compresses the gluteal tendons against the greater trochanter, which aggravates a compressive tendinopathy.

Q: Give the origin, insertion and action of gluteus medius. A: O: ilium between the anterior and posterior gluteal lines; I: lateral greater trochanter; A: hip abduction and pelvic stabilisation.

Q: How would you manage this beyond the treatment session? A: Isometric then progressive hip-abductor loading, avoiding provocative positions (crossing legs, standing 'on one hip'), and sleep-posture advice (pillow between knees).

References

Banks, K. (2013) _Maitland's Peripheral Manipulation Management._ Elsevier.
Banks, K. (2013) _Maitland's Vertebral Manipulation Management._ Elsevier.
Sharkey, J. (2017) _The Concise Book of Dry Needling._ Lotus Publishing.
Watson, T. (2008) _Electrotherapy: Evidence Based Practice._ Elsevier.
Clarkson, H. M. (2013) _Musculoskeletal Assessment._ 3rd edn. Lippincott.
TODO: add a condition-specific loading-protocol reference (from module notes), Harvard format.

Trochanteric Bursitis