GREATER TROCHANTERIC PAIN SYNDROME (GTPS)
There was well renown study done by a gentleman called John Furia, a New York orthopaedic surgeon, that changed the way people think about this syndrome. It can be a little bit of an awkward condition to heal and used to be called Trochanteric Bursitis but is now referred to as Greater Trochanteric Pain Syndrome, because it is pain around the entire trochanter area (the hip), rather than just with the Trochanteric Bursa.
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Pain is worse when lying on the effected side, especially at night. Worsened post weight bearing exercises walking, running and GTPS often gets worse with time. We understand with this condition that there is also a noticeable weakness with the lateral hip muscles.
Please included the deterioration
This essentially is pain and tenderness in the region of the great trochanter, the little bump on the side of the hip, where the outside of the thigh meets the buttock. It is a complicated area as there's 5 muscles at the site of attachment and like the shoulder, it's prone to degeneration. You can think of it as the rotator cuff of the hip.
The process we typically see, starts with tendinitis and we eventually get to the stage where we see tears within the tissues around the trochanter. There are three bursas in this area that can cause all sorts of problems because they act as a cushioning device. The superficial muscles then have to react and referred pain can develop in the back and the knee.
I am sent a number of patients, from senior orthopaedic surgeons, who have a new hip and they're experiencing GTPS type symptoms and irritation in the soft tissues. Though we have to work slightly differently with the procedure in this area, it works extremely well and saves revision surgery.
We look again for a clinical assessment to exclude any deeper hip pathology. This is fast becoming one of my personal favourite conditions to treat because we’re seeing such great results even with total hip replacements and glute-med tears.
GTPS has had NICE guidelines from 2011, so we know that it's a safe and effective treatment for those who haven't responded to conservative treatment. In some cases, especially those who are extreme incapacitated, 3-5 treatments many be required as evidenced by supporting research.
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