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Hip pain is common in middle aged and older people. It can limit your walking and make it difficult to get in and out of. a chair, the bath or up and down stairs and keep you awake at night.

The 2 most common conditions that cause pain around the hip are trochanteric bursitis/greater trochanteric pain syndrome and osteoarthritis . We will describe these common conditions below:

What is Greater Trochanteric Pain Syndrome?

Greater trochanteric pain syndrome (or GTPS for short) is a condition that causes pain on the outside of the hip. The anatomy of the area is complicated, but simplistically there are several layers of tendon tissue which move over each other or over the hip bone. To reduce friction between these layers they are separated by a bursa. A bursa consists of two thin layers of tissue with a small amount of thick slippery fluid allowing one layer to slide over the other. 

The pain is believed to be caused by either a problem with the tendons, with the bursa or both. The tendons can deteriorate in quality and get small tears in them (tendinopathy). The bursa can swell and thicken, and on occasions get excess fluid within it. The condition is sometimes called trochanteric bursitis

What are the symptoms

The most common symptom is pain on the outside (lateral aspect) of the hip. This is usually worse when walking, running or going up stairs. It is usually painful when lying on the hip, which causes your sleep to be disturbed, particularly if you have GTPS on both sides. There will be tenderness when pressing on the femur bone on lateral aspect of the hip.

Investigations

Diagnostic ultrasound is used to examine the trochanteric bursa, which lies over the femur or thigh bone on the outside of the hip. Ultrasound can also be used to look at the tendons, but they can often be difficult to see clearly, particularly in larger people. MRI is the best method of imaging the tendons.

Treatment

Physiotherapy is usually the first treatment to be tried. This may include strengthening and stretching exercises, ice and a degree of rest initially. Therapeutic ultrasound or shock wave treatment may help if it doesn’t settle with exercise. As the condition settles you can gradually resume your normal activities in a controlled way, a structured plan will help to ensure you maintain the improvement. 

If the condition does not respond, a steroid injection is usually the next step. This is targeted at the trochanteric bursa. This treatment can be performed with or without ultrasound guidance, but to get the steroid into the bursa ultrasound guidance is necessary. Steroid injections usually give relief from symptoms, but the problem can sometimes return after a few months.

Tendinopathy is a chronic or long term tendon condition