What happens in the greater trochanter area?
The greater trochanter is the platform to which the tendons of the gluteus medius and minimus muscles, which hold the pelvis when walking, are attached. Between the tendons, bone and fascia lata lie several bags. When tendons are overloaded, tendinopathy develops: the fibers lose their order, micro-tears appear and pain receptors become more sensitive. The bag becomes inflamed a second time. Therefore, the modern name of the condition is greater trochanteric pain syndrome.
- The tendons of the gluteus medius and minimus muscles are affected
- Inflammation of the trochanteric bursae is often secondary
- Possible partial tendon ruptures
- The joint remains healthy
- Sometimes associated with iliotibial band syndrome
Causes and risk factors
Most often, pain is triggered by a change in habitual activity: a sharp increase in walking or running, new shoes, prolonged standing work. Weakness of the gluteal muscles and gait features in which the pelvis falls to the side of the supporting leg contribute. Middle-aged women get sick more often due to their wider pelvis and femoral neck angle. Also important are excess weight, different leg lengths, previous hip surgeries and the habit of sleeping on one side.
- Female gender and age 40–60 years
- A sharp increase in loads, running on an inclined surface
- Weakness of the gluteus medius muscle
- Excess body weight
- Different leg lengths, scoliosis, flat feet
- Previous injuries and hip surgeries
Symptoms
The pain is felt exactly on the side of the thigh, above the bony prominence, and can be clearly indicated with a finger. It intensifies when a person lies on the affected side, gets up after sitting for a long time, climbs stairs or walks for a long time. Sometimes it hurts when you lie on your healthy side - the upper leg pulls on the tendons. Unlike arthrosis, movement in the hip joint remains full, and the pain does not go to the groin.
- Point pain when pressing on the greater trochanter
- Pain when lying on your side and at night
- Strengthening when walking, stairs, standing up
- Irradiation along the outer thigh, but not below the knee
- Lameness when walking for a long time
- The range of motion in the joint is preserved
Diagnostics
The examination provides the most information: the doctor finds the point of maximum pain above the trochanter and conducts tests with resistance to hip abduction and standing on one leg. Soft tissue ultrasound shows tendon thickening, fluid in the bursa, and partial tears. An X-ray of the pelvis is needed to rule out arthrosis of the hip joint and to see bone changes. An MRI is indicated for persistent pain, suspected tendon rupture, or if intervention is planned. For low back pain, the spine is additionally assessed.
- Examination with palpation and functional tests
- Ultrasound of soft tissues of the greater trochanter area
- X-ray of hip joints
- MRI of the hip joints for persistent pain
- Examination of the lumbar region with a mixed picture
Treatment and prevention
The main thing is to remove the overload and re-teach the gluteal muscles to work. Avoid lying on the affected side, place a pillow between your knees, and avoid the “leg-to-leg” position and standing with the pelvis tilted. The basis of treatment is a gradual program of pelvic abduction and stabilization exercises, which is selected by a physical therapy specialist. It is supplemented with short-course anti-inflammatory drugs and shock wave therapy. Glucocorticoid injections provide a quick but temporary effect and should not be overused due to the risk of tendon damage. Surgery is rarely required. Therapy is prescribed by a doctor.
- Unloading: do not sleep on the sore side, a pillow between the knees
- Gluteal exercise program
- Correction of weight and walking technique
- Shock wave and laser therapy
- Short course anti-inflammatory drugs
- Injections into the trochanteric area - strictly according to indications