Initial Management of Greater Trochanteric Pain Syndrome

Diagnosis

Radiographs should be obtained first to rule out other causes of hip pain, as recommended by the American College of Radiology 2, 1
Ultrasound can effectively detect trochanteric bursitis and differentiate it from other conditions, though it may be difficult to distinguish from gluteus medius tendinosis, according to the American College of Radiology 1
MRI is usually appropriate when evaluating for clinically suspected tendon, muscle, or ligament injury as the source of hip pain after negative or indeterminate radiographs, as suggested by the American College of Radiology 2, 3

Physical therapy with targeted exercises for the hip abductor muscles shows superior long-term outcomes compared to other interventions, as recommended by the American College of Sports Medicine 1
Activity modification to decrease repetitive loading of the damaged tendon and bursa is recommended by the American College of Sports Medicine 1
Land-based physical therapy interventions are conditionally recommended over aquatic therapy interventions by the American College of Rheumatology 4

NSAIDs are recommended for pain relief and anti-inflammatory effects by the American College of Gastroenterology 1
Acetaminophen should be considered as first-line pharmacologic treatment for mild to moderate pain, as recommended by the American Geriatrics Society 5
Daily dosage of acetaminophen should not exceed 4 grams per day, as suggested by the American Geriatrics Society 5

Corticosteroid injection into the trochanteric bursa can provide both diagnostic information and therapeutic benefit, as recommended by the American College of Rheumatology 1
Ultrasound guidance improves the accuracy of corticosteroid injections, according to the American Institute of Ultrasound in Medicine 1

Differentiation between trochanteric bursitis and gluteus medius/minimus tendinosis can be difficult, and the two conditions frequently coexist, as noted by the American College of Sports Medicine 1
Surgical intervention should only be considered after failure of 3-6 months of comprehensive conservative treatment, as recommended by the American Academy of Orthopaedic Surgeons 1

In patients with hip prostheses, extracapsular disease associated with adverse reactions to metal debris could be misinterpreted as trochanteric bursitis, as warned by the American Academy of Orthopaedic Surgeons 1
Local injections around the Achilles, patellar, and quadriceps tendons should be avoided given the risk of tendon rupture, as cautioned by the American College of Rheumatology 4
High-impact aerobic training involves rapid application of loads across joint structures and should be avoided, as advised by the American Geriatrics Society 5