Greater trochanteric pain is a common orthopaedic complaint. In the past, this was thought to be from an unexplained irritation of the bursa on the outside of the hip joint. Recently, it has been recognized that many cases of hip "bursitis" is actually from wear and tear (called tendinosis), or even complete tears, of the gluteus medius and minimus tendons, that attach just deep to the greater trochanteric bursa. The bursa becomes irritated secondarily to the partial or complete tears. This situation is directly analogous to "rotator cuff bursitis", where the bursa becomes inflamed and irritated secondary to underlying rotator cuff disease. Thus, some have called the gluteus medius and minimus tendons the "rotator cuff of the hip". Nowadays, many of us use the term greater trochanteric pain syndrome instead of "greater trochanteric bursitis", since the underlying issue typically is more from a tendon issue.
Patients with gluteus medius or minimus partial or complete tears typically have pain on the outside of their hip, as opposed to patients with hip arthritis, where the pain is typically near the groin. Patients typically complain of pain rolling over in bed on the affected side. Patients may note that they fatigue easily with prolonged walking. Most often, there is no "cause" or acute trauma they have suffered before having the pain.
If a patient has greater trochanteric pain syndrome, typically they will try anti-inflammatories or Tylenol, and note some, but incomplete, pain relief with this. If the pain persists, one should see a physician. Physical examination testing and possibly X-rays can rule out other causes of lateral sided hip pain. If the diagnosis is confirmed, initial treatment consists of physical therapy for stretching the IT Band (a band of tissue running down the outside of the hip) and strengthening of the weak gluteal muscles. If this does not help, the physician may perform an ultrasound guided hip injection, to alleviate the pain, and help the patient progress with physical therapy.
Should the pain persist despite multiple cortisone injections and quality physical therapy exercise, an MRI may be appropriate. A high quality MRI can visualize the gluteal tendons, and discern whether there is tendinosis or a partial or complete tear of the tendons. Hip arthroscopy surgeons have transferred the expertise gained from shoulder arthroscopic rotator cuff repair to the hip and hip gluteus medius or minimus tears can now be treated and repaired arthroscopically. Thin cameras and instruments are used through poke holes in the skin, allowing visualization of the deep structures. Anchors and sutures are then used to tie the gluteus medius and minimus back down to the bone, in anatomic position. This procedure is rather new, but the preliminary results have been promising. The bottom line is our understanding and treatment of greater trochanteric pain syndrome is expanding rapidly. If you are having lateral sided hip pain, the treatment options for this are expanding, and our techniques are getting more people with chronic lateral hip pain better.