GPAtlas🧭 When to suspect
Greater trochanteric pain syndrome (GTPS) is an umbrella term for lateral hip pain centred over the bony prominence on the outer hip, the greater trochanter. Although historically labelled "trochanteric bursitis", surgical, histological and imaging studies show the pain is usually a tendinopathy of the gluteus medius and/or minimus tendons – with or without secondary bursal inflammation. These tendons are sometimes called the "rotator cuff of the hip".
GTPS is common, accounting for roughly 10–20% of hip-pain presentations in primary care (incidence around 1.8 per 1000 per year), and is seen most often in women aged 40–60. The mechanism is compression: the iliotibial band (ITB) compresses the gluteal tendons against the greater trochanter when the hip moves into adduction – crossing the legs, lying on the side, or "hanging" on one hip when standing. Weak hip abductors cause a lateral pelvic tilt that increases this compressive load.
The typical patient describes aching or burning pain over the lateral hip, worse with weight-bearing (walking, stairs, prolonged standing) and characteristically when lying on the affected side at night, disturbing sleep. Pain may radiate down the lateral thigh but rarely below the knee. Groin pain with restricted internal rotation points instead to hip osteoarthritis (OA).
The key skills in primary care are to make the clinical diagnosis, distinguish GTPS from hip OA and lumbar referred pain, recognise red flags, and reassure that management is conservative and largely primary-care based.
| Condition | Typical pain pattern | Discriminating feature |
|---|---|---|
| GTPS | Lateral hip/thigh over the greater trochanter; worse lying on that side | Point tenderness over the trochanter; hip joint movement preserved |
| Hip osteoarthritis | Groin pain ± buttock; worse on weight-bearing | Restricted/painful internal rotation; morning stiffness |
| Lumbar referred pain / radiculopathy | Back pain radiating to the lateral hip or leg | Nerve-root signs; pain may go below the knee; varies with spine position |
| Meralgia paraesthetica | Burning/numbness over the anterolateral thigh | Sensory symptoms, no trochanteric tenderness; nerve compression at the inguinal ligament |
Source: Br J Gen Pract 2017 · NICE
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