Greater trochanteric pain syndrome: Definition, Uses, and Clinical Overview

Greater trochanteric pain syndrome Introduction (What it is)

Greater trochanteric pain syndrome is a clinical term for pain felt on the outside (lateral side) of the hip.
It usually relates to irritation or injury of the tendons and soft tissues around the greater trochanter, a bony landmark on the upper femur.
It is commonly used in orthopedics, sports medicine, and physical therapy to describe a recognizable pattern of lateral hip pain.
It helps clinicians discuss diagnosis and management without assuming a single cause.

Why Greater trochanteric pain syndrome used (Purpose / benefits)

The term Greater trochanteric pain syndrome is used to group several closely related causes of lateral hip pain under one practical label. Historically, many cases were called “trochanteric bursitis,” implying that an inflamed bursa (a small fluid-filled cushion) was the main issue. Over time, imaging and clinical evaluation have shown that pain in this region can come from multiple structures, especially the gluteal tendons (often described as “hip abductors”), with or without bursal involvement.

Using this syndrome-based term has several purposes:

• Clarifies the pain location and pattern. It highlights pain centered near the greater trochanter and worsened by certain positions or loads on the lateral hip.
• Avoids oversimplification. It does not assume the bursa is always the main driver, which can affect how clinicians think about testing and treatment options.
• Guides evaluation. It reminds clinicians to consider tendon pathology, biomechanical contributors, referred pain, and less common diagnoses.
• Supports shared language across specialties. Primary care, orthopedics, physiotherapy, and radiology can communicate effectively using a consistent label.

In general terms, it addresses the problem of localizing and explaining lateral hip pain, enabling structured assessment and a stepwise approach to symptom management and functional recovery.

Indications (When orthopedic clinicians use it)

Orthopedic and rehabilitation clinicians commonly use Greater trochanteric pain syndrome in scenarios such as:

• Lateral hip pain that is tender over the greater trochanter on exam
• Pain that worsens with side-lying on the affected hip
• Pain provoked by walking, climbing stairs, prolonged standing, or single-leg loading
• Hip pain with suspected gluteus medius or gluteus minimus tendon involvement (tendinopathy or partial tearing)
• Lateral hip pain after a change in activity level, training volume, or occupational demands
• Persistent “bursitis-like” symptoms when broader tendon and soft-tissue causes are being considered
• Lateral hip pain in patients with coexisting low back or pelvic conditions, where careful differentiation is needed

Contraindications / when it’s NOT ideal

Greater trochanteric pain syndrome is a diagnostic category, not a single treatment. “Not ideal” typically means the label may be incomplete, misleading, or needs to be replaced by another diagnosis after further evaluation. Situations where another approach may be more appropriate include:

• Red-flag features (for example, fever, unexplained weight loss, severe night pain, cancer history, or systemic illness), where infection, tumor, or inflammatory disease must be considered
• Acute trauma with inability to bear weight or marked functional loss, where fracture or major tendon rupture may be evaluated
• Prominent groin pain and stiffness suggesting intra-articular hip disease (such as osteoarthritis or femoroacetabular impingement), rather than lateral soft-tissue pain
• Neurologic symptoms (numbness, weakness, radiating pain below the knee) suggesting lumbar radiculopathy or other nerve-related conditions
• Pain primarily from the sacroiliac region or lumbar spine, where lateral hip tenderness is minimal and provocative hip tests are negative
• Generalized widespread pain patterns where a regional syndrome label does not capture the broader clinical picture

In many real-world cases, diagnoses overlap. Whether the label is appropriate varies by clinician and case.

How it works (Mechanism / physiology)

Greater trochanteric pain syndrome describes pain generated by tissues near the greater trochanter and the way those tissues respond to load.

Relevant anatomy and tissues

Key structures include:

• Greater trochanter: the bony prominence on the outer upper femur
• Gluteus medius and gluteus minimus tendons: hip abductor tendons inserting near the greater trochanter; they help stabilize the pelvis during walking and standing
• Trochanteric bursae: small fluid-filled sacs that can reduce friction between tendon and bone; they may become irritated alongside tendon problems
• Iliotibial band (IT band) and fascia lata: connective tissue structures that pass over the lateral hip and may contribute to compression or friction-like symptoms in some presentations
• Surrounding muscles and soft tissues: including gluteus maximus and deep hip rotators that influence hip mechanics

Physiologic and biomechanical principles

At a high level, symptoms are commonly thought to relate to tendon overload and compression at the lateral hip, sometimes paired with bursal irritation. Activities that increase hip adduction (the thigh moving toward the midline) or require prolonged single-leg support can increase demand on the hip abductors. In some people, this can contribute to tendon pain (tendinopathy) and sensitivity of adjacent structures.

Pain may be influenced by:

• Load tolerance of the tendon: how well the tendon handles repeated stress
• Tissue sensitivity: local tenderness and pain signaling that can persist even after the original trigger changes
• Movement patterns: pelvic control during gait, stair climbing, or standing
• Coexisting conditions: such as lumbar spine disorders or hip osteoarthritis, which can alter mechanics and pain perception

Onset, duration, and reversibility

Greater trochanteric pain syndrome is not a device or medication, so “onset and duration” do not apply in the same way. Instead, clinicians often describe the course as variable—some cases are short-lived, while others can be persistent or recurrent. Symptom reversibility and timeline vary by clinician and case, and may depend on factors like tissue severity, contributing biomechanics, and comorbidities.

Greater trochanteric pain syndrome Procedure overview (How it’s applied)

Greater trochanteric pain syndrome is not a single procedure. It is applied as a clinical framework used to evaluate, classify, and manage lateral hip pain. A typical high-level workflow may include:

1. Evaluation / history – Location of pain (lateral hip vs groin vs buttock vs back) – Triggers (walking, stairs, side-lying, recent activity changes) – Associated symptoms (stiffness, mechanical catching, neurologic symptoms)

2. Physical examination – Palpation tenderness over the greater trochanter – Functional testing of hip abductor strength and pain provocation – Screening of lumbar spine and neurologic findings when relevant

3. Preparation for testing (if needed) – Review of prior imaging or prior treatments – Consideration of risk factors or red flags that influence next steps

4. Intervention / testing – Many cases are assessed clinically without immediate imaging – When uncertainty exists, clinicians may consider imaging (often ultrasound or MRI) to evaluate tendons, bursae, and other hip structures – Diagnostic injections may be used in some settings to help localize pain generators (practice varies by clinician and case)

5. Immediate checks – Monitoring symptom response to activity modification or therapeutic trials – Reassessment when symptoms change, progress, or fail to improve

6. Follow-up – Periodic review of function, pain pattern, and contributing factors – Escalation or referral when the course is atypical or when another diagnosis becomes more likely

Types / variations

Greater trochanteric pain syndrome can present in different ways, and clinicians may describe subtypes based on suspected primary pain source or clinical course:

• Gluteal tendinopathy–predominant presentations
• Often involves the gluteus medius and/or gluteus minimus tendons

• May be described as degenerative tendinopathy, reactive tendinopathy, or partial tearing depending on clinical and imaging findings

• Bursa-involved presentations

• Trochanteric bursae may show signs of irritation

• The degree to which bursal findings correlate with symptoms can vary

• Iliotibial band–related lateral hip pain

• Sometimes described when lateral soft-tissue tightness or compression patterns are prominent

• Terminology varies across clinicians and disciplines

• Acute vs chronic Greater trochanteric pain syndrome

• Acute: more recent onset, often after a change in load or activity

• Chronic: symptoms persisting over time, sometimes with recurrences

• Primary vs secondary presentations

• Primary: lateral hip structures are the main issue
• Secondary: altered mechanics from spine, pelvis, or intra-articular hip conditions may contribute to lateral overload

Pros and cons

Pros:

• Provides a clear, location-based label for lateral hip pain
• Encourages clinicians to consider tendon involvement, not only “bursitis”
• Supports a structured evaluation (history, exam, selective imaging)
• Helps communication across care teams (orthopedics, PT, sports medicine)
• Allows management to be tailored to suspected tissue drivers and function
• Useful for explaining the condition to patients in understandable terms

Cons:

• It is a broad category, not a single diagnosis with one cause
• Overlap with lumbar spine or intra-articular hip conditions can complicate interpretation
• Imaging findings (like bursal fluid or tendon changes) do not always match symptom severity
• The label may delay recognition of uncommon causes if red flags are missed
• Terminology differs across clinicians (for example, continued use of “trochanteric bursitis”)
• Some cases require stepwise evaluation before the main pain driver is clear

Aftercare & longevity

Because Greater trochanteric pain syndrome is a diagnostic framework rather than a single intervention, “aftercare” usually refers to what happens after diagnosis and after any selected treatment approach (for example, rehabilitation strategies, activity planning, or procedures such as injections—when used).

Factors that commonly influence outcomes over time include:

• Severity and chronicity: longer-standing symptoms may involve more persistent sensitivity and functional compensation
• Tendon health and load tolerance: tendon-related cases may respond differently than predominantly bursal irritation
• Coexisting conditions: lumbar spine disorders, hip osteoarthritis, metabolic health factors, and generalized pain conditions can affect symptom persistence
• Daily activity demands: occupational standing/walking, stair use, and sport participation can influence symptom patterns
• Follow-up and reassessment: clinicians often adjust the working diagnosis if symptoms change or do not match expected patterns
• Consistency of rehabilitation participation: when rehabilitation is part of care, adherence and progression are often discussed as contributors to durability (specific plans vary by clinician and case)
• If a procedure is used: the longevity of symptom relief after interventions such as injections can vary by clinician and case, and may depend on diagnosis accuracy and concurrent rehabilitation

Alternatives / comparisons

Greater trochanteric pain syndrome is best understood as one way to categorize lateral hip pain; alternatives are often other diagnoses or different management pathways considered during evaluation.

Common comparisons include:

• Observation/monitoring vs active management
• Some presentations are monitored over time with reassessment, especially if symptoms are mild or improving

• Active management may be chosen when pain limits sleep, work, or mobility

• Physical therapy–led management vs injection-based approaches

• Rehabilitation approaches focus on movement patterns, hip strength, and graded loading
• Injections (when used) may be considered for symptom modulation or diagnostic clarification; techniques and medications vary by clinician and case

• These approaches are sometimes combined rather than treated as mutually exclusive

• Imaging strategies: ultrasound vs MRI

• Ultrasound can evaluate superficial soft tissues and guide injections in some settings
• MRI offers broader assessment of tendons, bursa, and intra-articular structures

• Choice depends on clinical question, availability, and clinician preference

• Greater trochanteric pain syndrome vs hip osteoarthritis

• Osteoarthritis more often presents with groin pain, stiffness, and reduced joint range of motion, though patterns can overlap

• Lateral hip pain can occur with osteoarthritis, so clinicians may consider both

• Greater trochanteric pain syndrome vs lumbar radiculopathy

• Radiculopathy often includes radiating leg pain, neurologic symptoms, or back-provoked symptoms

• Lateral hip tenderness and pain with local hip loading may support a local hip source, but overlap is common

• Surgery vs non-surgical care

• Surgery is not typical for most cases labeled Greater trochanteric pain syndrome
• In selected scenarios (for example, significant tendon tearing), surgical options may be discussed; thresholds vary by clinician and case

Greater trochanteric pain syndrome Common questions (FAQ)

Q: Where is the pain located with Greater trochanteric pain syndrome?
Pain is usually felt on the outside of the hip over the greater trochanter. Some people notice pain spreading into the outer thigh or buttock area. Pain location alone is not diagnostic, so clinicians combine location with exam findings.

Q: Is Greater trochanteric pain syndrome the same as trochanteric bursitis?
They overlap, but they are not identical. Trochanteric bursitis implies the bursa is the primary inflamed structure. Greater trochanteric pain syndrome is broader and often includes gluteal tendon pain with or without bursal involvement.

Q: What usually makes the pain worse?
Common aggravators include side-lying on the affected hip, walking longer distances, climbing stairs, and prolonged standing. Movements that increase demand on the hip abductors can also provoke symptoms. Exact triggers vary by clinician and case.

Q: How is it diagnosed—do I always need imaging?
Diagnosis is often clinical, based on history and a focused physical exam. Imaging may be used when the diagnosis is unclear, symptoms persist, or clinicians want to evaluate tendons and nearby structures. The decision depends on the clinical scenario and local practice patterns.

Q: What treatments are typically considered?
Management commonly includes education about the condition, structured rehabilitation approaches, and symptom-modulating options. Some clinicians consider medications or injections, and less commonly surgical evaluation if there is significant tendon injury. The exact plan varies by clinician and case.

Q: How long do symptoms last?
The course can be variable. Some cases improve over weeks, while others persist longer or recur, especially if contributing factors remain. Clinicians often track function (walking, stairs, sleep comfort) alongside pain intensity.

Q: Is it safe to keep working or exercising with this condition?
Safety and appropriate activity level depend on symptom severity, job demands, and whether another diagnosis is suspected. Many people remain active with modifications, but clinicians typically individualize recommendations. If pain is severe, rapidly worsening, or associated with red-flag symptoms, evaluation pathways may differ.

Q: Will I need crutches or restricted weight-bearing?
Most presentations do not automatically require restricted weight-bearing. However, severe pain, acute injury, or concern for a different diagnosis may change short-term activity planning. Decisions vary by clinician and case.

Q: Can Greater trochanteric pain syndrome come back after it improves?
Recurrence can happen, particularly when underlying load and movement factors are not fully addressed or when activity demands change. Follow-up reassessment may help clarify drivers of recurrence. Long-term patterns vary by individual.

Q: What does it cost to evaluate or treat?
Costs vary widely by region, insurance coverage, clinical setting, and whether imaging or procedures are used. Office visits, physical therapy, imaging, and injections can each change the overall cost range. Clinicians’ recommendations also vary by clinician and case.