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Greater trochanteric pain syndrome

Hip pain - greater trochanteric pain syndrome; GTPS; Bursitis of the hip; Hip bursitis

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Description

Greater trochanteric pain syndrome (GTPS) is pain that occurs on the outside of the hip. The greater trochanter is located at the top of the thighbone (femur) and is the most prominent and widest part of the hip.

Causes

GTPS can be caused by:

• Overuse or stress on the hip from exercising or standing for long periods
• Hip injury, such as from a fall
• Being overweight
• Recovery after hip or leg surgery
• Having one leg that is longer than the other
• Bone spurs on the hip
• Arthritis of the hip, knee, or foot
• Painful problems of the foot, such as a bunion, callas, plantar fasciitis, or Achilles tendon pain
• Spine problems, including scoliosis and arthritis of the spine
• Muscle imbalance that puts more stress around the hip muscles
• Tear in a buttocks muscle
• Infection (rare)

GTPS is more common in older adults. Being out of shape or overweight may put you at greater risk for hip bursitis. Women are more affected than men.

Symptoms

Common symptoms include:

• Pain at the side of the hip, which may also be felt on the outside of the thigh
• Pain that is sharp or intense at first, but may become more of an ache
• Difficulty walking
• Joint stiffness
• Swelling and warmth of the hip joint
• Catching and clicking sensation

You may notice the pain more when:

• Getting out of a chair or bed
• Sitting for a long time
• Walking up stairs
• Sleeping or lying on the affected side

Exams and Tests

Your health care provider will do a physical exam and ask about your symptoms. The provider may do the following during the exam:

• Ask you to point to the location of the pain
• Feel and press on your hip area
• Move your hip and leg as you lie or sit on the exam table
• Ask you to stand, walk, sit down and stand up
• Measure the length of each leg

To check for other conditions that could be causing your symptoms, you may have tests such as:

• X-rays
• Ultrasound
• MRI

Treatment

Many cases of GTPS go away with rest and self-care. Your provider may recommend that you try the following:

• Use an ice pack 3 to 4 times a day for the first 2 or 3 days.
• Take pain relievers such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) to help relieve pain and swelling.
• Avoid activities that make the pain worse.
• When sleeping, do not lie on the side that has bursitis.
• Avoid standing for long periods of time.
• When standing, stand on a soft, cushioned surface. Put an equal amount of weight on each leg.
• Placing a pillow between your knees when lying on your side can help decrease your pain.
• Wear comfortable, well-cushioned shoes with a low heel.
• Lose weight if you are overweight.
• Strengthen your core muscles.

As the pain goes away, your provider may suggest exercises to build strength and prevent muscle atrophy. You may need physical therapy if you have trouble moving the joint.

Other treatments include:

• Removing fluid from the bursa
• Steroid injection
• Surgery to repair or remove injured tissue

Prevention

To help prevent hip pain:

• Always warm up and stretch before exercising and cool down afterward. Stretch your quadriceps and hamstrings.
• Don't increase the distance, intensity, and amount of time you exercise all at the same time.
• Avoid running straight down hills. Walk down instead.
• Swim instead of running or cycling.
• Run on a smooth, soft surface, such as a track. Avoid running on cement.
• If you have flat feet, try special shoe inserts and arch supports (orthotics).
• Make sure your running shoes fit well and have good cushioning.

When to Call the Doctor

Contact your provider if symptoms come back or do not improve after 2 weeks of treatment.

Get medical help right away if you have any of the following:

• Your hip pain is caused by a serious fall or other injury
• Your leg is deformed, badly bruised, or bleeding
• You are unable to move your hip or bear any weight on your leg
• You have difficulty standing on one leg
• Your pain goes down your leg
• You have difficulty with urinary or bowel function

References

Brown ML, Bugbee WD. The hip. In: Hochberg MC, Gravallese EM, Smolen JS, Heijde D van der, Weinblatt ME, Weisman MH, eds. Rheumatology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 82.

Fredericson M, Lin CY, Chew K. Greater trochanteric pain syndrome. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 62.

Review Date: 12/12/2022  

Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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