Greater Trochanteric Pain Syndrome / Trochanteric Bursitis
Greater trochanteric pain syndrome (GTPS), also known as trochanteric bursitis, is inflammation of the trochanteric bursa, a part of the hip.
This bursa is at the top, outer side of the femur, between the insertion of the gluteus medius and gluteus minimus muscles into the greater trochanter of the femur and the femoral shaft. It has the function, in common with other bursae, of working as a shock absorber and as a lubricant for the movement of the muscles adjacent to it.
Occasionally, this bursa can become inflamed and clinically painful and tender. This condition can be a manifestation of an injury (often resulting from a twisting motion or from overuse), but sometimes arises for no obviously definable cause. The symptoms are pain in the hip region on walking, and tenderness over the upper part of the femur, which may result in the inability to lie in comfort on the affected side.
More often the lateral hip pain is caused by disease of the gluteal tendons that secondarily inflames the bursa. This is most common in middle-aged women and is associated with a chronic and debilitating pain which does not respond to conservative treatment. Other causes of trochanteric bursitis include uneven leg length, iliotibial band syndrome, and weakness of the hip abductor muscles.
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 Greater Trochanteric Pain Syndrome 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 occurring 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. Greater Trochanteric Pain Syndrome has been reported to affect between 10% and 25% of the general population, with an increased prevalence in women compared to men.
Treatment for symptomatic tendon tears comprises rest, anti-inflammatory medications and physiotherapy focusing on range of motion and strengthening exercises. Trochanteric bursitis is usually self-limiting and responds to rest, ice, anti-inflammatory medications and physiotherapy focusing on stretching, flexibility, strengthening and gait mechanics. When symptoms persist despite these interventions, bursal injections of local anaesthetics can provide effective pain relief.
Finally, shockwave therapy has proven to be extremely effective in treating chronic, recalcitrant Greater Trochanteric Pain Syndrome. 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.
Shockwave Therapy is:
- In Office Procedure
- Walk-In / Walk-Out
- No Time Off Work
- Clinically Proven
- No Drugs Or Side-Effects
Dolorclast Radial Shock Wave Therapy is a non-invasive treatment for the treatment of Greater Trochanteric Pain Syndrome.
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How does Dolorclast Shockwave Therapy work?
Dolorclast shockwave therapy works in 2 ways:
- Reducing pain by decreasing the chemical messengers responsible for the transmission and perception of pain
- Improved local blood flow to the sore area through the physical effects of the treatment and the promotion of new blood vessel growth in the area.
What does the Dolorclast Shockwave Therapy involve?
After the painful site is identified, shock waves are delivered to the site. Initially the treatment can be uncomfortable but as the treatment progresses the intensity usually improves. An instant improvement in pain is usually noted after the treatment.
The Foot and Ankle Clinic is proud to have pioneered the use of Shockwave Therapy in Australia since its inception several years ago and therefore all our Podiatrists have vast experience using shockwave therapy and have done extensive training in shockwave therapy and its applications.
At the Foot and Ankle Clinic our highly qualified team of Podiatrists are all members of the Australian Podiatry Association and offer a combined 50 years’ experience.
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