Greater trochanteric pain syndrome
CONSULT TREATMENT PROTOCOL

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ANATOMICAL AREAS



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GLOSSARY OF DISEASES

NameTissueType of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome
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MORE INFORMATION

Greater trochanteric pain syndrome (GTPS) includes a number of disorders of the lateral peritrochanteric space of the hip such as tears of the gluteus medius and minimus, trochanteric bursitis, and external coxa saltans.

The main clinical symptoms are pain and reproducible tenderness in the region of the greater trochanter and/or the buttock or lateral thigh. Diagnosis is based on the clinical features of the disease. Diagnostic imaging should be considered to rule out other causes of hip pain or to establish the diagnosis of GTPS when in doubt.

The greater trochanter is the site of attachment for the tendons of five muscles: the gluteus medius and gluteus minimus laterally, and the piriformis, obturator externus and obturator internus medially. As in the shoulder, injury and subsequent degeneration may occur in the components of the rotator cuff of the hip, starting with tendonitis, tendinosis, and eventual tear. This process is occuring more commonly in the gluteus medius than the gluteus minimus.

Furthermore, there are three bursas present around the lateral aspect of the greater trochanter, i.e., the subgluteus maximus bursa, the subgluteus medius bursa and the gluteus minimus bursa. These bursas are believed to serve as cushioning for the gluteus tendons, the iliotibial band, and the tensor fascia latae. Trochanteric bursitis occurs mostly secondary to repetitive friction between the greater trochanter and the iliotibial band with hip flexion and extension. Trochanteric bursitis is also often associated with overuse, trauma, or other conditions that may alter normal gait patterns.

GTPS has been reported to affect between 10% and 25% of the general population, with an increased prevalence in women compared to men.

Therapy of symptomatic tendon tears comprises rest, antiinflammatory medications and physiotherapy focusing on range of motion and strengthening exercises. Trochanteric bursitis is usually self-limiting and responds to rest, ice, antiinflammatory medications and physiotherapy focusing on stretching, flexibility, strengthening and gait mechanics. When symptoms persist despite these interventions, bursal injections of local anesthetics and corticosteroid can provide effective pain relief.

Radial shock wave therapy (RSWT) has been demonstrated to be efficient for recalcitrant GTPS. In case of inefficacy of RSWT, surgical intervention may be considered in cases in which other potential sources of the patient’s symptoms have been ruled out.

 

CLINICAL EVIDENCE

Rompe et al., Am J Sports Med 2009;37 1981-1990

Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome.

READ ABSTRACT

Furia et al., Am J Sports Med 2009;37:1806-1813

Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome

READ ABSTRACT

TREATMENT PROTOCOL

STANDARD TREATMENT MYOFASCIAL THERAPY
Number of treatment sessions 3 to 5 3 to 5
Interval between two sessions 1 week 1 week
Air pressure Evo Blue® 3 to 4 bar 3 to 4 bar
Air pressure Power+ 2.5 to 4 bar 2 to 4 bar
Impulses 2000 on the painful spot 2000
Frequency 8Hz to 12Hz 12Hz to 20Hz
Applicator 15mm 36mm
Skin pressure Moderate to Heavy Moderate to Heavy

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