Management of Greater Trochanteric Pain Syndrome: A Narrative Review

Greater trochanteric pain syndrome (GTPS) is characterized by pain and tenderness over the lateral aspect of the hip. It encompasses a spectrum of conditions, including abductor tendinopathy, trochanteric bursitis, and external coxa saltans. Following diagnosis, managing GTPS can be challenging due to the variability in pathology and the wide range of available treatments, many of which are supported by low levels of evidence. At present, there is no clear consensus on the optimal management approach for this condition. This review evaluates the existing literature on GTPS management, aiming to provide clinicians with a framework to guide treatment decisions. Articles were sourced from PubMed and MEDLINE using the terms "greater trochanteric pain syndrome", "trochanteric bursitis", and "gluteal tendinopathy". Findings suggest that targeted physiotherapy (PT) offers superior long-term outcomes compared to shock wave therapy and corticosteroid injections (CSI). In one study, 60.5% of patients reported symptom resolution at 15 months. Extracorporeal shock wave therapy (ESWT) demonstrated a 68.3% improvement in Visual Analogue Scale scores compared to control groups. Combining PT with CSI appears to be more effective in managing acute symptoms than PT alone. The evidence supporting platelet-rich plasma (PRP) remains inconclusive, with ongoing research needed to clarify its role. Surgical intervention is considered when conservative and medical treatments have failed, with various operative techniques showing improvements in pain scores over time. In conclusion, PT and home exercise programs have shown long-term benefits for most patients, although improvements may not be immediate. CSIs can offer short-term relief but are most effective when combined with PT for sustained benefit. Focused ESWT has limited but promising evidence supporting its use, with a low risk of adverse effects. Although PRP has shown potential in some studies, further research is necessary before it can be recommended as part of standard treatment protocols.