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The management of greater trochanteric pain syndrome: A systematic literature review

GTPS and the myth of trochanteric bursitis

In everyday clinical practice, lateral hip pain (GTPS = Greater Trochanteric Pain Syndrome) is very often synonymous with trochanteric bursitis. This is a myth, as both clinical experience and the literature show that bursitides are much less common than, for example, pathologies of the rotator cuff of the hip or the iliotibial ligament. Kohler et al presented data from a prospective observational study of 74 patients with pain syndrome in the trochanteric major region. In this study bursitis could only be shown in 46% of the patients. In more than 80% cortical irregularities were present in the area of insertion of the rotator cuff of the hip. Tendinopathies and lesions of the rotator cuff were the most common findings:

Ultrasound findings N (%)

Bursitis 34 (46.0)

Calcifications in gluteus medius 29 (39.2)

Calcifications in gluteus minimus 7 (9.5)

Enthesophytes at the insertion of the gluteus medius 7 (9.5)

Enthesophytes at the insertion of the gluteus minimus 1 (1.4)

Gluteus medius tendinopathy 57 (77.0)

Gluteus medius partial rupture 11 (14.9)

Gluteus medius transmural rupture 1 (1.4)

Gluteus minimus tendinopathy 10 (13.5)

Gluteus minimus partial rupture 3 (4.1)

Tensor fascia latae pathology 14 (18.9)

Tractus iliotibialis pathology 9 (12.2)

Ultrasound findings on the lateral hip in GTPS according to Kohler et al, ACR 2013

Quiroz et al presented a retrospective analysis of GTPS with 124 ultrasound examinations in 96 patients. Also in this study tendinopathies of the gluteus medius and/or gluteus minimus tendon were the main findings in about 50% of the examinations. Isolated bursitis without further pathologies was found in only 4% of the examinations. 14.5% of the ultrasound examinations showed a combination of tendinopathy and accompanying bursitis. In this study a good agreement between ultrasound and MRI findings could be shown. A group from Thomas Jefferson University Hospital (Long et al 2013) published data from its retrospective analysis of 877 patients where bursitis was found in only one fifth of the patients.