{"id":11314,"date":"2024-09-20T06:00:38","date_gmt":"2024-09-20T05:00:38","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314"},"modified":"2024-09-19T14:23:46","modified_gmt":"2024-09-19T13:23:46","slug":"the-msk-playbook-greater-trochanteric-pain-syndrome","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2024\/09\/20\/the-msk-playbook-greater-trochanteric-pain-syndrome\/","title":{"rendered":"The MSK playbook: Greater Trochanteric Pain Syndrome"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Greater Trochanteric Pain Syndrome (GTPS) is a common cause of lateral hip pain seen in the MSK clinic and can have a significant impact on patient&#8217;s function, and ability to exercise pain free. Understanding which lateral hip soft tissue structures are affected can help to design effective recovery and exercise strategies. We also discuss indications for imaging and when it can be used to guide injection, shockwave or pain-relieving procedures.<\/span><\/p>\n<p><b>Diagnosing GTPS<\/b><\/p>\n<p><span style=\"font-weight: 400\">GTPS is a condition diagnosed based on the presence of typical clinical symptoms affecting the lateral hip structures (1).\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pain with palpation<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pain that is worse with adducted hip positions,<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pain with weightbearing and resisted abduction\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">The absence of other hip conditions (OA\/FAI)\u00a0\u00a0<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11315\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS-300x300.png\" alt=\"\" width=\"391\" height=\"391\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS-300x300.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS-150x150.png 150w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS-768x768.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS-1536x1536.png 1536w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS-2048x2048.png 2048w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS-640x640.png 640w\" sizes=\"auto, (max-width: 391px) 100vw, 391px\" \/><\/p>\n<p><i><span style=\"font-weight: 400\">Figure 1: The sensitivities and specificities of clinic-based tests used in the assessment of GTPS<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">GTPS symptoms are often diffuse and travel to other structures. Symptoms may radiate down the thigh to the knee, to the gluteal region, or superior to the hip depending on which structures are impacted.\u00a0 Considering the results of these clinical tests in the context of the presenting complaint and risk factors is key to diagnosis.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11316\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-2-Single-Leg-Stand-Test-\u2013-SLS-test-149x300.png\" alt=\"\" width=\"174\" height=\"350\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-2-Single-Leg-Stand-Test-\u2013-SLS-test-149x300.png 149w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-2-Single-Leg-Stand-Test-\u2013-SLS-test.png 473w\" sizes=\"auto, (max-width: 174px) 100vw, 174px\" \/> <i><span style=\"font-weight: 400\">Figure 2: Single Leg Stand Test \u2013 SLS test<\/span><\/i><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-11317\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-3-Flexion-Adduction-External-rotation-\u2013-FADER-test--276x300.png\" alt=\"\" width=\"276\" height=\"300\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-3-Flexion-Adduction-External-rotation-\u2013-FADER-test--276x300.png 276w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-3-Flexion-Adduction-External-rotation-\u2013-FADER-test--640x695.png 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-3-Flexion-Adduction-External-rotation-\u2013-FADER-test-.png 745w\" sizes=\"auto, (max-width: 276px) 100vw, 276px\" \/><i><span style=\"font-weight: 400\">Figure 3: Flexion Adduction External rotation \u2013 FADER test\u00a0<\/span><\/i><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-11318\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-4-Resisted-hip-abduction-\u2013-in-side-lying-300x228.png\" alt=\"\" width=\"300\" height=\"228\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-4-Resisted-hip-abduction-\u2013-in-side-lying-300x228.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-4-Resisted-hip-abduction-\u2013-in-side-lying-640x487.png 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-4-Resisted-hip-abduction-\u2013-in-side-lying.png 650w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><i><span style=\"font-weight: 400\">Figure 4: Resisted hip abduction \u2013 in side lying<\/span><\/i><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-11319\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-5-FABER-test--300x244.png\" alt=\"\" width=\"300\" height=\"244\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-5-FABER-test--300x244.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-5-FABER-test-.png 638w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><i><span style=\"font-weight: 400\">Figure 5: FABER test\u00a0<\/span><\/i><\/p>\n<p><b>Understanding the burden of GTPS<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Cause of 10-20% of hip pain presenting to primary care (2,3)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Incidence of GTPS is 1.8 patients per 1000 per year (2)\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Prevalence highest amongst 40\u201360-year-olds \u2013 but can affect any age (3)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">1 in 4 women over 50 have been affected (4)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">The female: male ratio for GTPS is approximately 4:1 (4)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pain can be exacerbated by prolonged sitting, lying on affected side, climbing stairs and by high-intensity training<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Mean duration of symptoms prior to treatment is 7.1 weeks \u2013 4.4 years (4-6)<\/span><\/li>\n<\/ul>\n<p><b>A chronic overload of the soft tissues\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">GTPS is thought to be due to excessive or progressive overload of the soft tissue structures of the lateral hip. It is almost exclusively seen as a chronic condition, with acute or isolated inflammatory presentations in the minority. When working up patients in the MSK clinic it is important to be aware of the following risk factors:\u00a0<\/span><span style=\"font-weight: 400\">\u00a0\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Age (Middle age status 40-60)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Metabolic disrepair or metabolic medical conditions \u2013 (E.g. diabetes, Rheumatoid arthritis, high BMI)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Overload history\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Friction symptoms during provoking movements.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Sex (female sex is associated with an increased risk of GTPS)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Biomechanical risk factors (leg length discrepancy, scoliosis)<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11320\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-6-Intrinsic-v-Extrinsic-risk-factors-for-GTPS-212x300.png\" alt=\"\" width=\"314\" height=\"444\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-6-Intrinsic-v-Extrinsic-risk-factors-for-GTPS-212x300.png 212w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-6-Intrinsic-v-Extrinsic-risk-factors-for-GTPS-768x1086.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-6-Intrinsic-v-Extrinsic-risk-factors-for-GTPS-1086x1536.png 1086w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-6-Intrinsic-v-Extrinsic-risk-factors-for-GTPS-1448x2048.png 1448w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-6-Intrinsic-v-Extrinsic-risk-factors-for-GTPS-640x905.png 640w\" sizes=\"auto, (max-width: 314px) 100vw, 314px\" \/><\/p>\n<p><span style=\"font-weight: 400\"><i style=\"font-size: 1rem\">Figure 6: Intrinsic v Extrinsic risk factors for GTPS<\/i><br \/>\n<\/span><\/p>\n<p><b>The big two GTPS pathologies; tears and tendinopathy!<\/b><\/p>\n<p><span style=\"font-weight: 400\">By far the most common causes of GTPS are tendinopathy and partial thickness tears of the glute tendons. Understanding the underlying causes for these two conditions is key in aiding diagnosis and developing a treatment plan. Patients often attend with ideas about the diagnosis and that may be due to \u201chip bursitis\u201d or \u201ctrochanteric bursitis\u201d. Recent imaging and histological studies however have shown that where present associated bursae are almost exclusively a friction phenomenon with acute bursitis, rarely seen on histological or clinical presentations (7).<\/span><\/p>\n<p><b>A practical approach to GTPS; unpicking superficial v deep soft tissue causes<\/b><\/p>\n<p><span style=\"font-weight: 400\">The lateral hip soft tissue structures can be divided into the:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Superficial layer &#8211; Gluteus maximus and tensor fasciae latae (TFL)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Deep layer &#8211; Gluteus medius and gluteus minimus\u00a0<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400\">Each of these layers have their own function, biomechanical properties, and respond differently to load. Recent studies have shown that ITB and glute max (superficial layers), may have additional roles in absorbing elastic energy and improving the economy of movement, whilst the deep layer initiates and generates forces in hip abduction. Forces of up to 6-8 times body weight have been recorded during walking\/jogging across the literature (8).<\/span><\/p>\n<table style=\"height: 776px\" width=\"977\">\n<tbody>\n<tr>\n<td><\/td>\n<td><span style=\"font-weight: 400\">TFL \/ ITB \/ Gluteus Maximus<\/span><\/td>\n<td><span style=\"font-weight: 400\">Gluteus Medius \/ Gluteus Minimus<\/span><\/td>\n<td><span style=\"font-weight: 400\">TFL \/ ITB \/ Gluteus Maximus<\/span><\/td>\n<td><span style=\"font-weight: 400\">Gluteus Medius \/ Gluteus Minimus<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Lateral hip layer<\/span><\/td>\n<td><span style=\"font-weight: 400\">Superficial<\/span><\/td>\n<td><span style=\"font-weight: 400\">Deep<\/span><\/td>\n<td><span style=\"font-weight: 400\">Superficial<\/span><\/td>\n<td><span style=\"font-weight: 400\">Deep<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Activity<\/span><\/td>\n<td><span style=\"font-weight: 400\">Walking<\/span><\/td>\n<td><span style=\"font-weight: 400\">Walking<\/span><\/td>\n<td><span style=\"font-weight: 400\">Running<\/span><\/td>\n<td><span style=\"font-weight: 400\">Running<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Typical forces<\/span><\/td>\n<td><span style=\"font-weight: 400\">Compression forces negligible<\/span><\/td>\n<td><\/td>\n<td><span style=\"font-weight: 400\">Compressive forces<\/span><\/p>\n<p><span style=\"font-weight: 400\">++++<\/span><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Function<\/span><\/td>\n<td><span style=\"font-weight: 400\">ITB acts as a strut in frontal plane and energy storage<\/span><\/td>\n<td><span style=\"font-weight: 400\">Hip stabilisation Prevent Trendelenburg gait\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400\">ITB acts as a strut in frontal plane and energy storage\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400\">Hip stabilisation<\/span><\/p>\n<p><span style=\"font-weight: 400\">Prevent Trendelenburg gait\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Most active during which phase of movement\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400\">ITB\/TFL<\/span><\/p>\n<p><span style=\"font-weight: 400\">-Early swing<\/span><\/p>\n<p><span style=\"font-weight: 400\">&amp;<\/span><\/p>\n<p><span style=\"font-weight: 400\">-Support phase<\/span><\/p>\n<p><span style=\"font-weight: 400\">Gluteus Maximus<\/span><\/p>\n<p><span style=\"font-weight: 400\">-Trunk stabilisation<\/span><\/td>\n<td><\/td>\n<td><span style=\"font-weight: 400\">ITB\/TFL<\/span><\/p>\n<p><span style=\"font-weight: 400\">-Early swing<\/span><\/p>\n<p><span style=\"font-weight: 400\">-Beginning of stance phase<\/span><\/p>\n<p><span style=\"font-weight: 400\">-End of swing phase<\/span><\/p>\n<p><span style=\"font-weight: 400\">Gluteus Maximus<\/span><\/p>\n<p><span style=\"font-weight: 400\">-Initial contact phase \u2013 stops the hip going into flexion in impact (concentric)<\/span><\/p>\n<p><span style=\"font-weight: 400\">-Late swing phase \u2013 slows down hip flexion to get ready for contact (eccentric)<\/span><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Energy storage<\/span><\/td>\n<td><span style=\"font-weight: 400\">Yes &#8211; ITB<\/span><\/td>\n<td><span style=\"font-weight: 400\">No<\/span><\/td>\n<td><span style=\"font-weight: 400\">Yes \u2013 ITB<\/span><\/p>\n<p><span style=\"font-weight: 400\">Increasing elastic properties at higher speeds<\/span><\/td>\n<td><span style=\"font-weight: 400\">No<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"font-weight: 400\">\u00a0<\/span><i><span style=\"font-weight: 400\">Table 1: Explanation of the forces, energy storage, and function at each layer and muscle (9-11)<\/span><\/i><\/p>\n<p><b>The pathophysiology of GTPS<\/b><\/p>\n<p><span style=\"font-weight: 400\">When working up patients in the MSK clinic, it is important to ask about key risk factors that can influence rehab and response to treatment. These can be divided into medical, biomechanical, and degenerative causes.<\/span><\/p>\n<table>\n<tbody>\n<tr>\n<td><span style=\"font-weight: 400\">Medical\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400\">Biomechanical\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400\">Degenerative\/ tendinopathy\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">&#8211; Obesity (High BMI)<\/span><\/p>\n<p><span style=\"font-weight: 400\">&#8211; Enthesopathy secondary to medical conditions\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">&#8211; Diabetes<\/span><\/td>\n<td><span style=\"font-weight: 400\">&#8211; Deconditioning<\/span><\/p>\n<p><span style=\"font-weight: 400\">&#8211; Weak glutes<\/span><\/p>\n<p><span style=\"font-weight: 400\">&#8211; Pelvic tilt<\/span><\/p>\n<p><span style=\"font-weight: 400\">&#8211; External coxa saltans (snapping hip)<\/span><\/td>\n<td><span style=\"font-weight: 400\">&#8211; Post trauma<\/span><\/p>\n<p><span style=\"font-weight: 400\">&#8211; Tendinopathy features<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><i><span style=\"font-weight: 400\">Table 2: key risk factors that can influence GTPS rehab and treatment response (4, 6,12)<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">Whilst GTPS is predominantly a clinical diagnosis, imaging can be used to rule out significant pathology of the hip joint (OA), or to confirm the diagnosis in recalcitrant or persistent cases. X-rays can be used to assess hip OA and is the most widely available imaging modality.<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-11321\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-7-MRI-scan-300x254.png\" alt=\"\" width=\"300\" height=\"254\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-7-MRI-scan-300x254.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-7-MRI-scan.png 444w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/span><\/i><\/p>\n<p><i><span style=\"font-weight: 400\">Figure 7: MRI scan\u00a0<\/span><\/i><\/p>\n<p><i><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-11322\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-8-MRI-scan--300x236.jpg\" alt=\"\" width=\"300\" height=\"236\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-8-MRI-scan--300x236.jpg 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-8-MRI-scan--768x604.jpg 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-8-MRI-scan--640x504.jpg 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-8-MRI-scan-.jpg 1005w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/span><\/i><\/p>\n<p><i><span style=\"font-weight: 400\">Figure 8: MRI scan\u00a0<\/span><\/i><\/p>\n<p><b>Imaging the soft tissue of the lateral hip<\/b><\/p>\n<p><span style=\"font-weight: 400\">Point of care Ultrasound and MRI both have, good sensitivity and specificity for assessing soft tissue structure of the lateral hip. Ultrasound has the added benefit of being easily accessible, allows for dynamic examination, (snapping phenomena) and also allows you to assess soft tissue structure in clinic\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Gluteus Medius tears and tendinopathy are most commonly picked up by point of care ultrasound or MRI. In the absence of red flags serious pathology of the underlying hip joints is rarely found. Comparing the two, ultrasound is the cheaper, quicker and more widely accessible mode of imaging.<\/span><\/p>\n<table>\n<tbody>\n<tr>\n<td><b>Finding<\/b><\/td>\n<td><b>MRI Reporting Rates (%)<\/b><\/td>\n<td><b>USS Reporting Rates (%)<\/b><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Gluteus medius tear (partial or full thickness)<\/span><\/td>\n<td><span style=\"font-weight: 400\">46 \u2013 63<\/span><\/td>\n<td><span style=\"font-weight: 400\">1-33<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Gluteus medius tendinopathy<\/span><\/td>\n<td><span style=\"font-weight: 400\">37-73\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400\">34-71<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Gluteus minimus tendinopathy<\/span><\/td>\n<td><span style=\"font-weight: 400\">29<\/span><\/td>\n<td><span style=\"font-weight: 400\">13-23<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Trochanteric bursitis<\/span><\/td>\n<td><span style=\"font-weight: 400\">8 \u2013 40<\/span><\/td>\n<td><span style=\"font-weight: 400\">8-75<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Thickened ITB<\/span><\/td>\n<td><span style=\"font-weight: 400\">&#8211;<\/span><\/td>\n<td><span style=\"font-weight: 400\">0-29<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Partial ITB tear<\/span><\/td>\n<td><span style=\"font-weight: 400\">&#8211;<\/span><\/td>\n<td><span style=\"font-weight: 400\">1<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Enthesopathy<\/span><\/td>\n<td><span style=\"font-weight: 400\">&#8211;<\/span><\/td>\n<td><span style=\"font-weight: 400\">22<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Avascular necrosis of femoral head<\/span><\/td>\n<td><span style=\"font-weight: 400\">4<\/span><\/td>\n<td><span style=\"font-weight: 400\">&#8211;<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><i><span style=\"font-weight: 400\">Table 3: imaging findings and MRI vs USS reporting rates (13-16)<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">Ultrasound and MRI both provide soft tissue detail and can be used to image the soft tissues of the lateral hip. There is however a significant false positive rate for imaging findings, and many imaging findings for tendinopathy can be seen in asymptomatic patients (13,14,17). A study by Grimaldi et al. (18) found that 31% of participants with MRI findings suggestive of gluteal tendinopathy had no clinical symptoms of GTPS. It is important to put any imaging findings in the context of the pre-test findings (18,19).<\/span><\/p>\n<p><b>Common MRI findings seen on Imaging \u2013 GTPS (example cases)<\/b><\/p>\n<table>\n<tbody>\n<tr>\n<td><b>MRI Finding<\/b><\/td>\n<td><\/td>\n<td><b>Sensitivity (%)<\/b><\/td>\n<td><b>Specificity (%)<\/b><\/td>\n<td><b>Accuracy (%)<\/b><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">High signal superior to greater trochanter<\/span><\/td>\n<td><\/td>\n<td><span style=\"font-weight: 400\">73<\/span><\/td>\n<td><span style=\"font-weight: 400\">95<\/span><\/td>\n<td><span style=\"font-weight: 400\">91<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Tendon elongation in gluteus medius muscle<\/span><\/td>\n<td><\/td>\n<td><span style=\"font-weight: 400\">53<\/span><\/td>\n<td><span style=\"font-weight: 400\">86<\/span><\/td>\n<td><span style=\"font-weight: 400\">80<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Tendon discontinuity<\/span><\/td>\n<td><\/td>\n<td><span style=\"font-weight: 400\">27<\/span><\/td>\n<td><span style=\"font-weight: 400\">100<\/span><\/td>\n<td><span style=\"font-weight: 400\">85<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">High signal lateral to greater trochanter<\/span><\/td>\n<td><\/td>\n<td><span style=\"font-weight: 400\">53<\/span><\/td>\n<td><span style=\"font-weight: 400\">80<\/span><\/td>\n<td><span style=\"font-weight: 400\">74<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Atrophy of abductor muscles<\/span><\/td>\n<td><\/td>\n<td><span style=\"font-weight: 400\">40<\/span><\/td>\n<td><span style=\"font-weight: 400\">86<\/span><\/td>\n<td><span style=\"font-weight: 400\">77<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Overall MRI diagnosis of tendon tear defined by triad of:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">tendon discontinuity<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">an area of T2 hyperintensity superior to the greater trochanter<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">tendon elongation in the gluteus medius<\/span><\/li>\n<\/ol>\n<\/td>\n<td><\/td>\n<td><span style=\"font-weight: 400\">93<\/span><\/td>\n<td><span style=\"font-weight: 400\">92<\/span><\/td>\n<td><span style=\"font-weight: 400\">91<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><i><span style=\"font-weight: 400\">Table 4: common MRI findings seen on imaging for GTPS \u2013 example cases (20).<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">One shortfall when it comes to treatment is expecting a rapid resolution in symptoms with almost 50% experiencing ongoing pain at one year (21).\u00a0 We know from imaging studies that symptoms are typically driven by tendinopathic changes at the glute tendons which is linked to metabolic health, and metabolic dysregulation. GTPS is commonly seen in peri-menopausal and middle Aged patient with other medial risk factors (21-23). Therefore, arguably the most important interventions involve improving metabolic health, education around tendon loading, lifestyle measures and identifying reversible risk factors. (Figure 5). Treatment in MSK settings should involve discussions around:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Exercise prescription<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Weight management<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Social prescribing\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pain management options\u00a0<\/span><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11323\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-9-treatment-hierarchy-for-gluteal-tendinopathy-300x158.png\" alt=\"\" width=\"427\" height=\"225\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-9-treatment-hierarchy-for-gluteal-tendinopathy-300x158.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-9-treatment-hierarchy-for-gluteal-tendinopathy.png 500w\" sizes=\"auto, (max-width: 427px) 100vw, 427px\" \/><\/span><\/i><\/p>\n<p><i><span style=\"font-weight: 400\">Figure 9: treatment hierarchy for gluteal tendinopathy.<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">Education regarding load management can offer some quick wins to help alleviate symptoms by reducing compressive load through the tendons, or snapping of the tendons with external coxa saltans. This has been shown to offer significant change in pain and function in as little as 8-12 weeks, irrespective of the exercise programme (21, 24). Examples include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>Sleep <\/b><span style=\"font-weight: 400\">\u2013 on your back, or the unaffected side with a pillow between the knees or purchasing a mattress topper.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Sitting <\/b><span style=\"font-weight: 400\">\u2013 look to reduce time spent in cross-legged positions or in positions of deep hip flexion as it can increase compressive load.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Track Step Count<\/b><span style=\"font-weight: 400\"> \u2013 adequate load management is key and monitoring steps is a useful method to help prevent overloading the tendon.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Terrain <\/b><span style=\"font-weight: 400\">\u2013 for our athletic population, considering a temporary reduction with incline or cambered terrain during running will help.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">It is important to inform the patient that none of these positions are inherently bad. Yet, temporarily reducing them may offer sufficient relief, especially in the earlier phases with reactive tendinopathy subtypes. This is advantageous as it may facilitate a return to meaningful activities and thus improve quality of life, especially when different exercise regimes have not illustrated superior outcomes (21).<\/span><\/p>\n<p><b>Exercise<\/b><\/p>\n<p><span style=\"font-weight: 400\">Exercise forms the mainstay of initial treatment for lower limb tendinopathies with the rationale designed to restore capacity towards the tendon (25). Individuals with GTPS have demonstrated hip abduction strength deficits accompanied with altered biomechanics whilst walking, with increased hip adduction and contralateral pelvic drop (9). Although unable to prove whether this is association or causation, we can hypothesise these deficits may influence symptoms due to greater compressive load through the tendons and this is something we can look to target during rehabilitation.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Exercise combined with education appears to be superior versus a wait and see approach at short and long-term outcomes (24). Yet, the type of exercise doesn\u2019t appear to have much of an influence on success and this supports the notion that improved outcomes might not solely be due to physiological changes, but instead better self-efficacy (24, 26, 27). Additionally, those with more advanced GTPS have demonstrated higher BMIs, psychological distress and reduced activity (28). Therefore, encouraging generic forms of physical activity such as aquatic therapy, cycling or walking, particularly in a social\/supportive environment may help address these variables. For specific exercises, a stepped approach which looks to progressively load the tendon at high intensity without provoking symptoms is essential for tendinopathies, with a particular emphasis towards the frontal plane in GTPS (29, 31). Some examples are illustrated in Figure 6.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11324\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-10-exercises-for-lateral-hip-pain-238x300.jpg\" alt=\"\" width=\"270\" height=\"340\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-10-exercises-for-lateral-hip-pain-238x300.jpg 238w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-10-exercises-for-lateral-hip-pain-640x808.jpg 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-10-exercises-for-lateral-hip-pain.jpg 687w\" sizes=\"auto, (max-width: 270px) 100vw, 270px\" \/><\/p>\n<p><i><span style=\"font-weight: 400\">Figure 10: exercises for lateral hip pain.<\/span><\/i><\/p>\n<p><b>Corticosteroid Injections (CSI)<\/b><\/p>\n<p><span style=\"font-weight: 400\">Once considered the first line treatment for GTPS, injections are now encouraged to be used more judiciously. CSI offer a significant reduction in pain intensity with 75% of patients reporting a significant improvement in symptoms at one month, but these effects gradually decreased with time (31). More recently, a single CSI outperformed a wait and see approach at two months and one year but was less effective compared to education and exercise for success on global rating of change. The risk of repetitive injections must be balanced against tendon health, and higher doses may impact tendon health (homeostasis) (32). Especially as isolated bursitis in the absence of tendinopathic changes to the hip abductors is extremely rare (33).<\/span><\/p>\n<p><b>Other Interventions\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">There is a paucity of research surrounding taping for GTPS. One study compared dynamic taping versus sham and found both offered improvements in pain, whilst the former influenced hip biomechanics whilst walking (34). Further studies are needed to ascertain the physiological effects of taping on this condition.\u00a0\u00a0<\/span><\/p>\n<p><b>KEY GTPS TREATMENTS (3):<\/b><span style=\"font-weight: 400\"><br \/>\n<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400\">Weight loss<\/span><\/li>\n<li><span style=\"font-weight: 400\">NSAIDs<\/span><\/li>\n<li><span style=\"font-weight: 400\">Ice<\/span><\/li>\n<li><span style=\"font-weight: 400\">Taping\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400\">Rest<\/span><\/li>\n<li><span style=\"font-weight: 400\">Targeted physiotherapy (tailored to individual but focusing on gluteal strength and control followed by hip abductor strength)<\/span><\/li>\n<li><span style=\"font-weight: 400\">Load modification (sleeping with pillows in between legs to reduce compression on gluteal tendons)<\/span><\/li>\n<li><span style=\"font-weight: 400\">Biomechanical optimisation (avoid excessive hip adduction positions \u2013 i.e. crossing legs or excessive ITB stretching)<\/span><\/li>\n<li><span style=\"font-weight: 400\">Shockwave therapy (ESWT)<\/span><\/li>\n<li><span style=\"font-weight: 400\">Therapeutic ultrasound\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400\">Corticosteroid injections<\/span><\/li>\n<li><span style=\"font-weight: 400\">Platelet rich plasma (PRP) injections<\/span><\/li>\n<li><span style=\"font-weight: 400\">Surgical intervention (only after failed conservative management \u2013 may involve lengthening\/release of ITB and fascia lata or gluteal tendon repair)<\/span><\/li>\n<\/ul>\n<p><b>LEAP trial \u2013 key findings (24):<\/b><\/p>\n<p><span style=\"font-weight: 400\">The LEAP trial was a randomised clinical trial conducted in Australia which aimed to compare the effects of an education about tendon load management with a specific exercise programme of 14 sessions over 8 weeks, a single corticosteroid injection and a wait-and-see approach on pain and general improvement in people aged between 35-70 with gluteal tendinopathy (lateral hip pain for &gt; 3 months). Patients were asked to report a change in hip condition and pain intensity during the last week at eight weeks, followed by a longer follow-up at 52 weeks.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Outcomes<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">189\/204 participants completed the 52-week follow-up<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Education with exercise reported less pain than corticosteroid injections<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Education with exercise and corticosteroid injection use had higher rates of global improvement and lower pain scores than wait and see patients at eight weeks<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">At 52 weeks, education with exercise had better global improvement than corticosteroid injections, but there was no difference in pain intensity\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Education with exercise is supported as an effective management plan for gluteal tendinopathy based on these results<\/span><\/li>\n<\/ul>\n<p><b>Injection Therapies for GTPS<\/b><\/p>\n<p><span style=\"font-weight: 400\">Injection therapies can play an important role in the treatment of greater trochanteric pain syndrome, especially when other conservative management practices strategies have failed to achieve adequate symptom control.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>Corticosteroid Injections<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Can be effective in providing pain relief and functional improvements, but repetitive injection may impact long term tendon health. The total steroid burden and frequency of injections should be discussed as part of a shared decision making process.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>New orthobiologic injection approaches &#8211; Platelet Rich Plasma (PRP)\u00a0\u00a0<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Studies have shown that these may be more effective and provide more long-term pain relief (Table 5). PRP injection have the benefit of avoiding steroid burden and can be combined with or without dry needling procedures. The aim of these injections is to improve tendon health and provide a regenerative approach to treatment.<\/span><\/p>\n<table style=\"height: 306px\" width=\"999\">\n<tbody>\n<tr>\n<td><b>Authors<\/b><\/td>\n<td><b>Type of Study<\/b><\/td>\n<td><b>Comparison of Treatments<\/b><\/td>\n<td><b>Outcomes<\/b><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Fitzpatrick et al. (35)<\/span><\/td>\n<td><span style=\"font-weight: 400\">Double blind randomised control trial with 2 year follow up<\/span><\/td>\n<td><span style=\"font-weight: 400\">PRP injection\u00a0 vs. corticosteroid injection<\/span><\/td>\n<td><span style=\"font-weight: 400\">A single PRP injection resulted in greater and longer lasting improvements in pain and function than a single corticosteroid injection.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The effects of the PRP were sustained at 2 years, whereas the improvements from the corticosteroid injection peaked at 6 weeks and were not maintained beyond 24 weeks.<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Migliorini et al. (36)<\/span><\/td>\n<td><span style=\"font-weight: 400\">Systematic review and meta-analysis<\/span><\/td>\n<td><span style=\"font-weight: 400\">PRP injection vs. corticosteroid injection<\/span><\/td>\n<td><span style=\"font-weight: 400\">PRP injections provide much longer and more sustained pain relief when compared to corticosteroid injections.<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><i><span style=\"font-weight: 400\">Table 5: Summary of notable studies comparing PRP injections to corticosteroid injections<\/span><\/i><\/p>\n<p><b>Shockwave therapy<\/b><\/p>\n<p><span style=\"font-weight: 400\">Extracorporeal shock wave therapy (ESWT) has been found to be a suitable alternative treatment option for GTPS by several studies (37). Seo et al found that low-energy ESWT can be an effective treatment for chronic GTPS but over time the effects decrease (38).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Ramon et al. (37)\u00a0 found that when ESWT is completed in conjunction with a specific exercise programme, it is effective for GTPS, with a high success rate of 86.8% that was maintained until the end of the follow up period (6 months)<\/span><\/p>\n<p><span style=\"font-weight: 400\">Pressure waves from ESWT can deliver a mechanical force to the tendons, which stimulates blood flow (increasing rates of healing). Shockwaves can mimic forces that occur during trauma and can promote healing and regeneration (39).<\/span><\/p>\n<table style=\"height: 236px\" width=\"1029\">\n<tbody>\n<tr>\n<td><b>Authors<\/b><\/td>\n<td><b>Type of Study<\/b><\/td>\n<td><b>Comparison of Treatments<\/b><\/td>\n<td><b>Outcomes<\/b><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Heaver et al. (40)<\/span><\/td>\n<td><span style=\"font-weight: 400\">Randomised control trial<\/span><\/td>\n<td><span style=\"font-weight: 400\">Focussed shockwave therapy vs. ultrasound guided corticosteroid injection\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400\">At 12 months, the shockwave group had significantly better pain and functional scores compared to the corticosteroid injection group.<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Ramon et al. (37)<\/span><\/td>\n<td><span style=\"font-weight: 400\">Randomised control trial<\/span><\/td>\n<td><span style=\"font-weight: 400\">Shockwave therapy and exercise vs. sham shockwave therapy and exercise<\/span><\/td>\n<td><span style=\"font-weight: 400\">Significantly better pain and functional outcomes in the shockwave group through 6 months of follow up.\u00a0However, more studies are needed.<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Harding et al. (41)<\/span><\/td>\n<td><span style=\"font-weight: 400\">Systematic review and meta-analysis<\/span><\/td>\n<td><span style=\"font-weight: 400\">Shockwave therapy vs control treatments<\/span><\/td>\n<td><span style=\"font-weight: 400\">There is only low strength evidence that shockwave can lead to greater clinical improvements over time when compared to control treatments.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><i><span style=\"font-weight: 400\">Table 6: Summary of notable studies assessing the use of extracorporeal shockwave therapy\u00a0<\/span><\/i><\/p>\n<p><b>Fascial plane block<\/b><\/p>\n<p><span style=\"font-weight: 400\">Ultrasound guidance has been used to help with targeting joints, muscles, nerves and tendons for procedures. For the hip specifically, ultrasound guidance has become increasingly common practice for procedures involving the lateral and posterior hip (42). The superior gluteal nerve innervates the superior femoral neck, postero-lateral hip joint capsule and the lateral hip muscles (gluteus medius, gluteus minimus and tensor fasciae latae). As the SGN innervates the lateral hip muscles, it is a potential block target for patients presenting with GTPS.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Fascial plane blocks are a regional anaesthesia technique where the plane between two fascial layers is targeted by anaesthetic, which spreads to nerves within this plane and the adjacent tissues.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Ferreira-Dos-Santos et al. (42) found that whilst the fascial plane block is able to block the SGN without involving the sciatic or inferior gluteal nerves, further randomised controlled clinical trials are necessary to assess the effects of fasical plane blocks of the SGN in moderate-to-severe and chronic GTPS.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11325\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-11-Facial-plane-block-from-Ferriera-Dos-Santos-et-al.-42-300x67.jpg\" alt=\"\" width=\"407\" height=\"91\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-11-Facial-plane-block-from-Ferriera-Dos-Santos-et-al.-42-300x67.jpg 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-11-Facial-plane-block-from-Ferriera-Dos-Santos-et-al.-42-768x170.jpg 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-11-Facial-plane-block-from-Ferriera-Dos-Santos-et-al.-42-640x142.jpg 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-11-Facial-plane-block-from-Ferriera-Dos-Santos-et-al.-42.jpg 1430w\" sizes=\"auto, (max-width: 407px) 100vw, 407px\" \/><\/p>\n<p><i><span style=\"font-weight: 400\">Figure 11: <\/span><\/i><span style=\"font-weight: 400\">Facial plane block from Ferriera-Dos Santos et al. (42)<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11326\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-12-Fascial-plane-block-from-Ferriera-Dos-Santos-et-al.-42-300x110.jpg\" alt=\"\" width=\"404\" height=\"148\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-12-Fascial-plane-block-from-Ferriera-Dos-Santos-et-al.-42-300x110.jpg 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-12-Fascial-plane-block-from-Ferriera-Dos-Santos-et-al.-42-768x280.jpg 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-12-Fascial-plane-block-from-Ferriera-Dos-Santos-et-al.-42-640x234.jpg 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-12-Fascial-plane-block-from-Ferriera-Dos-Santos-et-al.-42.jpg 1430w\" sizes=\"auto, (max-width: 404px) 100vw, 404px\" \/><\/p>\n<p><i><span style=\"font-weight: 400\">Figure 12: <\/span><\/i><span style=\"font-weight: 400\">Fascial plane block from Ferriera-Dos Santos et al. (42)<\/span><\/p>\n<p><b>Conclusion\u00a0<\/b><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">GTPS is a common cause of lateral hip pain in working age patients, associated with chronic MSK pain and restriction to exercise.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Understanding the function and structural properties of the \u201cDeep V Superficial\u201d soft tissues layers of the lateral hip can help to plan rehab and aid clinical reasoning around treatment options.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Point of care ultrasound, is increasingly available in MSK clinics and can be used to assess the gluteal tendons, and plan injection therapy for recalcitrant cases<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Treatment options for GTPS, should start with patient education, optimising metabolic risk factors and exercise. Shockwave therapy, injection options or pain interventions can be considered on a personalised basis, taking into account symptom severity and duration.\u00a0<\/span><\/li>\n<\/ol>\n<p><strong>Authors:<\/strong><\/p>\n<p>Lynsey Abbey Joslin, Dr Ryan Linn, Dr Imran Lasker, Charlie\u00a0Clements, Dr Guilherme Ferreira-Dos-Santos, MD, Mr Tom Edgeley Dr Dr Jeffrey Peng, Dr Irfan Ahmed.<\/p>\n<p><b>Lynsey Abbey Joslin<\/b><\/p>\n<p><span style=\"font-weight: 400\">Medical Student,\u00a0<\/span><span style=\"font-weight: 400\">University College London (UCL)<\/span><\/p>\n<p><b>Dr Ryan Linn<\/b><\/p>\n<p><span style=\"font-weight: 400\">Foundation Year 1 Doctor,\u00a0<\/span><span style=\"font-weight: 400\">University Hospitals of North Midlands<\/span><\/p>\n<p><span style=\"font-weight: 400\">Twitter: @Ryan_Linn_<\/span><\/p>\n<p><b>Dr Imran Lasker<\/b><\/p>\n<p><span style=\"font-weight: 400\">Consultant Radiologist with Special Interest in MSK,\u00a0<\/span><span style=\"font-weight: 400\">Mid &amp; South Essex Foundation Trust<\/span><\/p>\n<p><span style=\"font-weight: 400\">Twitter: @DocLasker<\/span><\/p>\n<p><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=http%3A%2F%2Fwww.mskplaybook.com%2F&amp;data=05%7C02%7Cabbey.joslin.20%40ucl.ac.uk%7Cfd4a92432c6c4ee4fb4108dc96f67283%7C1faf88fea9984c5b93c9210a11d9a5c2%7C0%7C0%7C638551232510156955%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=yeeAIHGSgKnw8Vw%2FCqVxPYDKjiSYwdATC8gUkZrb1DI%3D&amp;reserved=0\"><span style=\"font-weight: 400\">www.mskplaybook.com<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400\">Links to MSK\/MRI courses: imranlasker.com, radiologyseminars.com. emergencyimaging.co.uk<\/span><\/p>\n<p><b>Charlie<\/b><b>\u00a0Clements\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">Sirona Care &amp; Health,\u00a0<\/span><span style=\"font-weight: 400\">First Contact Physiotherapist\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Twitter @ClementsCharl96\u00a0<\/span><\/p>\n<p><b>Dr Guilherme Ferreira-Dos-Santos, MD<\/b><\/p>\n<p><span style=\"font-weight: 400\">Senior Specialist and Responsible Clinical Lead for the Education and Training Excellence Center in Pain Medicine, accredited by the European Society of Regional Anesthesia and Pain Therapy<\/span><\/p>\n<p><span style=\"font-weight: 400\">Affilitation: Division of Pain Medicine, Department of Anesthesiology, Reanimation, and Pain Medicine, Hospital Cl\u00ednic de Barcelona, University of Barcelona. Barcelona, Spain.<\/span><\/p>\n<h6><b>Dr Jeffrey Peng MD, CAQSM<\/b><\/h6>\n<p><span style=\"font-weight: 400\">Sports Medicine Physician<\/span><\/p>\n<p><span style=\"font-weight: 400\">Clinical Assistant Professor (Affiliated); Stanford University School of Medicine, Department of Medicine, Division of Primary Care &amp; Population Health<\/span><\/p>\n<p><span style=\"font-weight: 400\">Twitter: @JeffreyPengMD<\/span><\/p>\n<p><span style=\"font-weight: 400\">YouTube:\u00a0<\/span><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.youtube.com%2Fc%2FJeffreyPengMD&amp;data=05%7C02%7Cryan.linn.18%40ucl.ac.uk%7C43c9708856064fdd5b0308dc2cb112fb%7C1faf88fea9984c5b93c9210a11d9a5c2%7C0%7C0%7C638434386250648387%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=6WjCtZbHbZjcxHhAHxRCn5sOgQp%2BFWyLgVaaicC99gI%3D&amp;reserved=0\"><span style=\"font-weight: 400\">youtube.com\/c\/JeffreyPengMD<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400\">Website: <\/span><a href=\"http:\/\/www.jeffreypengmd.com\/\"><span style=\"font-weight: 400\">www.JeffreyPengMD.com<\/span><\/a><\/p>\n<p><b>Mr Tom Edgeley<\/b><\/p>\n<p><span style=\"font-weight: 400\">Health advisor,\u00a0<\/span><span style=\"font-weight: 400\">BUPA St Albans\u00a0<\/span><\/p>\n<p><b>Dr Irfan Ahmed\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">Consultant in Musculoskeletal, Sport &amp; Exercise Medicine<\/span><\/p>\n<p><span style=\"font-weight: 400\">twitter @exerciseirfan<\/span><\/p>\n<p><a href=\"http:\/\/www.mskplaybook.com\/\"><span style=\"font-weight: 400\">www.mskplaybook.com<\/span><\/a><\/p>\n<p><strong>References<\/strong><span style=\"font-weight: 400\"><br \/>\n<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment.\u00a0<\/span><i><span style=\"font-weight: 400\">Anesth Analg<\/span><\/i><span style=\"font-weight: 400\">. 2009;108(5):1662-1670. doi:10.1213\/ane.0b013e31819d6562<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Lievense A, Bierma-Zeinstra S, Schouten B, Bohnen A, Verhaar J, Koes B. Prognosis of trochanteric pain in primary care.\u00a0<\/span><i><span style=\"font-weight: 400\">Br J Gen Pract<\/span><\/i><span style=\"font-weight: 400\">. 2005;55(512):199-204.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Speers CJ, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. Br J Gen Pract. 2017;67(663):479-480. doi:10.3399\/bjgp17X693041<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors.\u00a0<\/span><i><span style=\"font-weight: 400\">Arch Phys Med Rehabil<\/span><\/i><span style=\"font-weight: 400\">. 2007;88(8):988-992. doi:10.1016\/j.apmr.2007.04.014<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Livingston JI, Deprey SM, Hensley CP. DIFFERENTIAL DIAGNOSTIC PROCESS AND CLINICAL DECISION MAKING IN A YOUNG ADULT FEMALE WITH LATERAL HIP PAIN: A CASE REPORT.\u00a0<\/span><i><span style=\"font-weight: 400\">Int J Sports Phys Ther<\/span><\/i><span style=\"font-weight: 400\">. 2015;10(5):712-722.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pumarejo Gomez L, Li DD, Childress JM. Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis). In:\u00a0<\/span><i><span style=\"font-weight: 400\">StatPearls<\/span><\/i><span style=\"font-weight: 400\">. Treasure Island (FL): StatPearls Publishing; February 25, 2024.<\/span><\/li>\n<li>\n<div>Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol. 2013 Nov;201(5):1083-6. doi: 10.2214\/AJR.12.10038. PMID: 24147479.<\/div>\n<\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Grumet RC, Frank RM, Slabaugh MA, Virkus WW, Bush-Joseph CA, Nho SJ. Lateral hip pain in an athletic population: differential diagnosis and treatment options.\u00a0<\/span><i><span style=\"font-weight: 400\">Sports Health<\/span><\/i><span style=\"font-weight: 400\">. 2010;2(3):191-196. doi:10.1177\/1941738110366829<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Jeong DE, Lee SK, Kim K. Comparison of the activity of the gluteus medius according to the angles of inclination of a treadmill with vertical load.\u00a0<\/span><i><span style=\"font-weight: 400\">J Phys Ther Sci<\/span><\/i><span style=\"font-weight: 400\">. 2014;26(2):251-253. doi:10.1589\/jpts.26.251.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Eng CM, Arnold AS, Lieberman DE, Biewener AA. The capacity of the human iliotibial band to store elastic energy during running.\u00a0<\/span><i><span style=\"font-weight: 400\">J Biomech<\/span><\/i><span style=\"font-weight: 400\">. 2015;48(12):3341-3348. doi:10.1016\/j.jbiomech.2015.06.017<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Lieberman DE, Raichlen DA, Pontzer H, Bramble DM, Cutright-Smith E. The human gluteus maximus and its role in running.\u00a0<\/span><i><span style=\"font-weight: 400\">J Exp Biol<\/span><\/i><span style=\"font-weight: 400\">. 2006;209(Pt 11):2143-2155. doi:10.1242\/jeb.02255<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Kadar A, Itzikovitch R, Warschawski Y, Morgan S, Shemesh S. Diabetes Mellitus Is a Possible Risk Factor for the Development of Trochanteric Bursitis-A Large-Scale Population-Based Study. J Clin Med. 2023 Sep 24;12(19):6174. doi: 10.3390\/jcm12196174. PMID: 37834819; PMCID: PMC10573166.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Kingzett-Taylor A, Tirman PF, Feller J, et al. Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings.\u00a0<\/span><i><span style=\"font-weight: 400\">AJR Am J Roentgenol<\/span><\/i><span style=\"font-weight: 400\">. 1999;173(4):1123-1126. doi:10.2214\/ajr.173.4.10511191<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome.\u00a0<\/span><i><span style=\"font-weight: 400\">Arthritis Rheum<\/span><\/i><span style=\"font-weight: 400\">. 2001;44(9):2138-2145. doi:10.1002\/1529-0131(200109)44:9&lt;2138::AID-ART367&gt;3.0.CO;2-M<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol. 2013;201(5):1083-1086. doi:10.2214\/AJR.12.10038<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Hilligs\u00f8e M, Rathleff MS, Olesen JL. Ultrasound Definitions and Findings in Greater Trochanteric Pain Syndrome: A Systematic Review.\u00a0<\/span><i><span style=\"font-weight: 400\">Ultrasound Med Biol<\/span><\/i><span style=\"font-weight: 400\">. 2020;46(7):1584-1598. doi:10.1016\/j.ultrasmedbio.2020.03.008<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Blankenbaker DG, Ullrick SR, Davis KW, De Smet AA, Haaland B, Fine JP. Correlation of MRI findings with clinical findings of trochanteric pain syndrome.\u00a0<\/span><i><span style=\"font-weight: 400\">Skeletal Radiol<\/span><\/i><span style=\"font-weight: 400\">. 2008;37(10):903-909. doi:10.1007\/s00256-008-0514-8<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Grimaldi A, Mellor R, Nicolson P, Hodges P, Bennell K, Vicenzino B. Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain. Br J Sports Med. 2017;51(6):519-524. doi:10.1136\/bjsports-2016-096175<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Westacott DJ, Minns JI, Foguet P. The diagnostic accuracy of magnetic resonance imaging and ultrasonography in gluteal tendon tears&#8211;a systematic review. Hip Int. 2011;21(6):637-645. doi:10.5301\/HIP.2011.8759<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Cvitanic O, Henzie G, Skezas N, Lyons J, Minter J. MRI diagnosis of tears of the hip abductor tendons (gluteus medius and gluteus minimus).\u00a0<\/span><i><span style=\"font-weight: 400\">AJR Am J Roentgenol<\/span><\/i><span style=\"font-weight: 400\">. 2004;182(1):137-143. doi:10.2214\/ajr.182.1.1820137<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Ganderton C, Semciw A, Cook J, Moreira E, Pizzari T. Gluteal Loading Versus Sham Exercises to Improve Pain and Dysfunction in Postmenopausal Women with Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial.\u00a0<\/span><i><span style=\"font-weight: 400\">J Womens Health (Larchmt)<\/span><\/i><span style=\"font-weight: 400\">. 2018;27(6):815-829. doi:10.1089\/jwh.2017.6729<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Abate M, Schiavone C, Salini V, Andia I. Occurrence of tendon pathologies in metabolic disorders.\u00a0<\/span><i><span style=\"font-weight: 400\">Rheumatology (Oxford)<\/span><\/i><span style=\"font-weight: 400\">. 2013;52(4):599-608. doi:10.1093\/rheumatology\/kes395<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pianka MA, Serino J, DeFroda SF, Bodendorfer BM. Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology.\u00a0<\/span><i><span style=\"font-weight: 400\">SAGE Open Med<\/span><\/i><span style=\"font-weight: 400\">. 2021;9:20503121211022582. Published 2021 Jun 3. doi:10.1177\/20503121211022582<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial.\u00a0<\/span><i><span style=\"font-weight: 400\">Br J Sports Med<\/span><\/i><span style=\"font-weight: 400\">. 2018;52(22):1464-1472. doi:10.1136\/bjsports-2018-k1662rep<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Patricio Cordeiro TT, Rocha EAB, Scattone Silva R. Effects of exercise-based interventions on gluteal tendinopathy. Systematic review with meta-analysis.\u00a0<\/span><i><span style=\"font-weight: 400\">Sci Rep<\/span><\/i><span style=\"font-weight: 400\">. 2024;14(1):3343. Published 2024 Feb 9. doi:10.1038\/s41598-024-53283-x<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Clifford C, Paul L, Syme G, Millar NL. Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study.\u00a0<\/span><i><span style=\"font-weight: 400\">BMJ Open Sport Exerc Med<\/span><\/i><span style=\"font-weight: 400\">. 2019;5(1):e000558. Published 2019 Sep 21. doi:10.1136\/bmjsem-2019-000558<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Mellor R, Kasza J, Grimaldi A, Hodges P, Bennell K, Vicenzino B. Mediators and Moderators of Education Plus Exercise on Perceived Improvement in Individuals With Gluteal Tendinopathy: An Exploratory Analysis of a 3-Arm Randomized Trial.\u00a0<\/span><i><span style=\"font-weight: 400\">J Orthop Sports Phys Ther<\/span><\/i><span style=\"font-weight: 400\">. 2022;52(12):826-836. doi:10.2519\/jospt.2022.11261<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Plinsinga ML, Coombes BK, Mellor R, et al. Psychological factors not strength deficits are associated with severity of gluteal tendinopathy: A cross-sectional study.\u00a0<\/span><i><span style=\"font-weight: 400\">Eur J Pain<\/span><\/i><span style=\"font-weight: 400\">. 2018;22(6):1124-1133. doi:10.1002\/ejp.1199<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">\u00a0Grimaldi A, Mellor R, Nasser A, Vicenzino B, Hunter DJ. Current and future advances in practice: tendinopathies of the hip.\u00a0<\/span><i><span style=\"font-weight: 400\">Rheumatol Adv Pract<\/span><\/i><span style=\"font-weight: 400\">. 2024;8(2):rkae022. Published 2024 Apr 10. doi:10.1093\/rap\/rkae022<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pavlova AV, Shim JSC, Moss R, et al. Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis.\u00a0<\/span><i><span style=\"font-weight: 400\">Br J Sports Med<\/span><\/i><span style=\"font-weight: 400\">. 2023;57(20):1327-1334. doi:10.1136\/bjsports-2022-105754<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">\u00a0Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome.\u00a0<\/span><i><span style=\"font-weight: 400\">Am J Sports Med<\/span><\/i><span style=\"font-weight: 400\">. 2009;37(10):1981-1990. doi:10.1177\/0363546509334374<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Dean BJ, Lostis E, Oakley T, Rombach I, Morrey ME, Carr AJ. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon.\u00a0<\/span><i><span style=\"font-weight: 400\">Semin Arthritis Rheum<\/span><\/i><span style=\"font-weight: 400\">. 2014;43(4):570-576. doi:10.1016\/j.semarthrit.2013.08.006<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Lange J, Tvedes\u00f8e C, Lund B, Bohn MB. Low prevalence of trochanteric bursitis in patients with refractory lateral hip pain.\u00a0<\/span><i><span style=\"font-weight: 400\">Dan Med J<\/span><\/i><span style=\"font-weight: 400\">. 2022;69(7):A09210714. Published 2022 Jun 15.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">\u00a0Robinson NA, Spratford W, Welvaert M, Gaida J, Fearon AM. Does Dynamic Tape change the walking biomechanics of women with greater trochanteric pain syndrome? A blinded randomised controlled crossover trial.\u00a0<\/span><i><span style=\"font-weight: 400\">Gait Posture<\/span><\/i><span style=\"font-weight: 400\">. 2019;70:275-283. doi:10.1016\/j.gaitpost.2019.02.031<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Fitzpatrick J, Bulsara MK, O&#8217;Donnell J, Zheng MH. Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up. Am J Sports Med. 2019;47(5):1130-1137. doi:10.1177\/0363546519826969<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Migliorini F, Kader N, Eschweiler J, Tingart M, Maffulli N. Platelet-rich plasma versus steroids injections for greater trochanter pain syndrome: a systematic review and meta-analysis. Br Med Bull. 2021;139(1):86-99. doi:10.1093\/bmb\/ldab018<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Ramon S, Russo S, Santoboni F, et al. Focused Shockwave Treatment for Greater Trochanteric Pain Syndrome: A Multicenter, Randomized, Controlled Clinical Trial.\u00a0<\/span><i><span style=\"font-weight: 400\">J Bone Joint Surg Am<\/span><\/i><span style=\"font-weight: 400\">. 2020;102(15):1305-1311. doi:10.2106\/JBJS.20.00093<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Seo KH, Lee JY, Yoon K, et al. Long-term outcome of low-energy extracorporeal shockwave therapy on gluteal tendinopathy documented by magnetic resonance imaging.\u00a0<\/span><i><span style=\"font-weight: 400\">PLoS One<\/span><\/i><span style=\"font-weight: 400\">. 2018;13(7):e0197460. Published 2018 Jul 17. doi:10.1371\/journal.pone.0197460<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Manning, B.\u00a0 How shockwave therapy helps heal sports and overuse injuries [internet]. Dallas: UT Southwestern Medical Center; 2022 (cited: 2024 July 23). Available from: <\/span><a href=\"https:\/\/utswmed.org\/medblog\/sports-injuries-shockwave-therapy\/\"><span style=\"font-weight: 400\">https:\/\/utswmed.org\/medblog\/sports-injuries-shockwave-therapy\/<\/span><\/a><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Heaver C, Pinches M, Kuiper JH, et al. Greater trochanteric pain syndrome: focused shockwave therapy versus an ultrasound guided injection: a randomised control trial. Hip Int. 2023;33(3):490-499. doi:10.1177\/11207000211060396<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Harding D, Cameron L, Monga A, Winter S. Is shockwave therapy effective in the management of greater trochanteric pain syndrome? A systematic review and meta-analysis. Musculoskeletal Care. 2024;22(2):e1892. doi:10.1002\/msc.1892<\/span><\/li>\n<li><span style=\"font-weight: 400\">Ferreira-Dos-Santos G, Hurdle MFB, Tran J, Eldrige JS, Clendenen SR, Agur AMR. Ultrasound-Guided Gluteal Fascial Plane Block for the Treatment of Chronic Refractory Greater Trochanteric Pain Syndrome &#8211; Technique Description and Anatomical Correlation Study.\u00a0<\/span><i style=\"font-size: 1rem\">Pain Med<\/i><span style=\"font-weight: 400\">. 2022;23(11):1875-1881. doi:10.1093\/pm\/pnac071<\/span><\/li>\n<\/ol>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Greater Trochanteric Pain Syndrome (GTPS) is a common cause of lateral hip pain seen in the MSK clinic and can have a significant impact on patient&#8217;s function, and ability to exercise pain free. Understanding which lateral hip soft tissue structures are affected can help to design effective recovery and exercise strategies. We also discuss indications [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2024\/09\/20\/the-msk-playbook-greater-trochanteric-pain-syndrome\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":463,"featured_media":11315,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[16068,16326,1874,16306,16315],"class_list":["post-11314","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-featured","tag-greater-trochanter","tag-hip-pain","tag-msk","tag-mskplaybook"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The MSK playbook: Greater Trochanteric Pain Syndrome - BJSM blog - social media&#039;s leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/?p=11314\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The MSK playbook: Greater Trochanteric Pain Syndrome - BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"Greater Trochanteric Pain Syndrome (GTPS) is a common cause of lateral hip pain seen in the MSK clinic and can have a significant impact on patient&#8217;s function, and ability to exercise pain free. Understanding which lateral hip soft tissue structures are affected can help to design effective recovery and exercise strategies. We also discuss indications [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bjsm\/?p=11314\" \/>\n<meta property=\"og:site_name\" content=\"BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"article:published_time\" content=\"2024-09-20T05:00:38+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS.png\" \/>\n\t<meta property=\"og:image:width\" content=\"4000\" \/>\n\t<meta property=\"og:image:height\" content=\"4000\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"bjsm\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"bjsm\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"23 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314\"},\"author\":{\"name\":\"bjsm\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#\\\/schema\\\/person\\\/02b7ae2dae6231c8629aa4da74bb9e6b\"},\"headline\":\"The MSK playbook: Greater Trochanteric Pain Syndrome\",\"datePublished\":\"2024-09-20T05:00:38+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314\"},\"wordCount\":4417,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2024\\\/09\\\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS.png\",\"keywords\":[\"featured\",\"greater trochanter\",\"hip pain\",\"msk\",\"MSKplaybook\"],\"articleSection\":[\"General\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314\",\"name\":\"The MSK playbook: Greater Trochanteric Pain Syndrome - BJSM blog - social media&#039;s leading SEM voice\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2024\\\/09\\\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS.png\",\"datePublished\":\"2024-09-20T05:00:38+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2024\\\/09\\\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2024\\\/09\\\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS.png\",\"width\":4000,\"height\":4000},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=11314#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"The MSK playbook: Greater Trochanteric Pain Syndrome\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/\",\"name\":\"BJSM blog - social media&#039;s leading SEM voice\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#organization\",\"name\":\"BJSM blog - social media&#039;s leading SEM voice\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2017\\\/11\\\/blog-logo-bjsm.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2017\\\/11\\\/blog-logo-bjsm.png\",\"width\":222,\"height\":34,\"caption\":\"BJSM blog -  social media&#039;s leading SEM voice\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#\\\/schema\\\/person\\\/02b7ae2dae6231c8629aa4da74bb9e6b\",\"name\":\"bjsm\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g\",\"caption\":\"bjsm\"},\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/author\\\/nifferco\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"The MSK playbook: Greater Trochanteric Pain Syndrome - BJSM blog - social media&#039;s leading SEM voice","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314","og_locale":"en_US","og_type":"article","og_title":"The MSK playbook: Greater Trochanteric Pain Syndrome - BJSM blog - social media&#039;s leading SEM voice","og_description":"Greater Trochanteric Pain Syndrome (GTPS) is a common cause of lateral hip pain seen in the MSK clinic and can have a significant impact on patient&#8217;s function, and ability to exercise pain free. Understanding which lateral hip soft tissue structures are affected can help to design effective recovery and exercise strategies. We also discuss indications [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314","og_site_name":"BJSM blog - social media&#039;s leading SEM voice","article_published_time":"2024-09-20T05:00:38+00:00","og_image":[{"width":4000,"height":4000,"url":"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS.png","type":"image\/png"}],"author":"bjsm","twitter_card":"summary_large_image","twitter_misc":{"Written by":"bjsm","Est. reading time":"23 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314"},"author":{"name":"bjsm","@id":"https:\/\/blogs.bmj.com\/bjsm\/#\/schema\/person\/02b7ae2dae6231c8629aa4da74bb9e6b"},"headline":"The MSK playbook: Greater Trochanteric Pain Syndrome","datePublished":"2024-09-20T05:00:38+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314"},"wordCount":4417,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS.png","keywords":["featured","greater trochanter","hip pain","msk","MSKplaybook"],"articleSection":["General"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bjsm\/?p=11314#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314","url":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314","name":"The MSK playbook: Greater Trochanteric Pain Syndrome - BJSM blog - social media&#039;s leading SEM voice","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS.png","datePublished":"2024-09-20T05:00:38+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bjsm\/?p=11314"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314#primaryimage","url":"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS.png","contentUrl":"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/09\/Figure-1-The-sensitivities-and-specificities-of-clinic-based-tests-used-in-the-assessment-of-GTPS.png","width":4000,"height":4000},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bjsm\/?p=11314#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bjsm\/"},{"@type":"ListItem","position":2,"name":"The MSK playbook: Greater Trochanteric Pain Syndrome"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bjsm\/#website","url":"https:\/\/blogs.bmj.com\/bjsm\/","name":"BJSM blog - social media&#039;s leading SEM voice","description":"","publisher":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bjsm\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bjsm\/#organization","name":"BJSM blog - social media&#039;s leading SEM voice","url":"https:\/\/blogs.bmj.com\/bjsm\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bjsm\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bjsm\/files\/2017\/11\/blog-logo-bjsm.png","contentUrl":"https:\/\/blogs.bmj.com\/bjsm\/files\/2017\/11\/blog-logo-bjsm.png","width":222,"height":34,"caption":"BJSM blog -  social media&#039;s leading SEM voice"},"image":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bjsm\/#\/schema\/person\/02b7ae2dae6231c8629aa4da74bb9e6b","name":"bjsm","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g","caption":"bjsm"},"url":"https:\/\/blogs.bmj.com\/bjsm\/author\/nifferco\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/11314","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/users\/463"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/comments?post=11314"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/11314\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/media\/11315"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/media?parent=11314"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/categories?post=11314"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/tags?post=11314"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}