Trochanteric bursitis is only one possible cause of lateral hip pain. Greater trochanteric pain syndrome (GTPS) is a broader diagnosis that includes gluteus medius and minimus tendinopathy, bursal involvement and other pathology around the greater trochanter. In a large ultrasound series, only 20% of patients with greater trochanteric pain had bursitis, while about 50% had gluteal tendinosis. That is why tenderness over the side of the hip should not automatically be labeled bursitis.
What is greater trochanteric pain syndrome?
GTPS is pain and tenderness around the greater trochanter, the bony point on the outside of the hip. It is a regional clinical syndrome rather than a single tissue diagnosis. Several structures sit in this small area: the gluteus medius and minimus tendons, which attach to the trochanter; the trochanteric bursae; and the fascia lata and IT band passing over the top. The condition is especially common in middle-aged and older women.
Why "trochanteric bursitis" is often too narrow a label
For years, pain on the side of the hip was routinely called trochanteric bursitis, and treatment often focused on the bursa. Gluteal tendinopathy is now regarded as the primary local source of lateral hip pain in many people, with the old label reflecting an earlier understanding. Bursitis still occurs and can coexist with tendon changes. The problem is assuming it in everyone.
What the 877-patient ultrasound study found
Long and colleagues reviewed six years of hip ultrasound examinations performed for greater trochanteric pain at a US academic center, published in the American Journal of Roentgenology in 2013.
| Finding | Patients | Share |
|---|---|---|
| Gluteal tendinosis | 438 | 49.9% |
| Thickened IT band | 250 | 28.5% |
| Trochanteric bursitis | 177 | 20.2% |
| Gluteal tendon tear | 4 | 0.5% |
These categories are not mutually exclusive, and many patients had more than one finding. In an ultrasound series of 877 patients with greater trochanteric pain, only about one in five had bursitis. Gluteal tendinosis was substantially more common. The authors concluded that greater trochanteric pain is usually some combination of gluteal tendon and IT band pathology, with bursitis present in a minority.
The study does not show that bursitis diagnoses are wrong in any particular patient. It shows that bursitis should not be the default explanation.
What does gluteal tendinopathy feel like?
- Pain over the outside of the hip around the greater trochanter
- Pain lying on the affected side, which can disturb sleep
- Pain with prolonged walking, climbing stairs or hills
- Pain standing on one leg
- Pain getting up after sitting, in some people
- Flare-ups after a sudden increase in walking or running
The pattern is suggestive, not diagnostic. Hip joint and spinal problems can produce overlapping symptoms.
How are the gluteal tendons loaded?
The gluteus medius and minimus stabilize the pelvis every time you stand on one leg, so their tendons carry tensile load with each step. When the hip moves toward adduction, with the thigh drawn across the body, the IT band and tendons press harder against the greater trochanter. Reviews by Grimaldi and colleagues describe excessive compression combined with high tensile load as the combination thought to be most damaging to tendons, and identify hip adduction as a key factor.
That model is useful, but it should not be overstated. Crossing your legs does not cause tendinopathy. Positions that increase sustained compression may aggravate an already sensitive tendon.
What clinical tests actually tell us
Clinical examination can materially change the likelihood of GTPS. Kinsella and colleagues pooled diagnostic accuracy studies in a 2024 meta-analysis in the Journal of Orthopaedic and Sports Physical Therapy: 6 studies, 272 participants and 314 hips.
| Situation | Estimated probability of GTPS |
|---|---|
| Before testing, in people with lateral hip pain | 59% |
| Positive greater trochanter palpation, then positive resisted hip abduction | 96% |
| Negative greater trochanter palpation, then negative resisted hip abduction | 14% |
In a diagnostic meta-analysis, positive greater trochanter palpation plus resisted hip abduction increased the estimated probability from 59% to 96%; when both were negative, it fell to 14%. The pair strongly shifts probability, but it is not a perfect test. Certainty of evidence across the individual tests ranged from very low to moderate, and the studies were small.
Does an MRI confirm gluteal tendinopathy?
Imaging can identify tendinosis and tendon tears, but structural changes also occur in people without lateral hip pain. In a 2017 study of women in the Journal of Women's Health, Ganderton and colleagues scanned a subgroup of 16 women with GTPS and 17 without symptoms. All of the symptomatic women had gluteal tendon changes on MRI, but so did 88% of the asymptomatic women, ranging from mild tendinosis to full-thickness tear.
The sample was small, so it does not mean MRI has little value. It means a tendon finding on a scan has to be matched to symptoms and examination before it is treated as the cause of pain.
GTPS vs. hip osteoarthritis
Hip osteoarthritis more often causes pain in the groin or front of the hip, stiffness after rest and loss of hip rotation. GTPS pain is usually centered on the outside of the hip and reproduced by pressure over the trochanter or by loading the abductors. The two can overlap, and some people have both.
GTPS vs. lumbar referred pain and sciatica
The lower back can refer pain into the buttock, hip and thigh. Back pain, pain spreading below the knee, numbness, tingling or weakness make a spinal or nerve-root contribution more likely. GTPS pain can also spread down the outer thigh, so that by itself does not mean sciatica. Spinal and lateral hip problems can coexist. These are covered in low back pain and sciatica and nerve entrapment.
When is imaging useful?
- A suspected significant tendon tear
- Marked abductor weakness
- Pain that started with a fall or injury
- Unusual symptoms, or features of serious pathology
- No improvement after appropriate conservative care
- Planning for injection or surgery
- Suspected hip joint pathology
Does the label change treatment?
It can. Education about tendon loading and progressive exercise have strong evidence in gluteal tendinopathy, and shockwave has a growing but mixed evidence base, reviewed in shockwave therapy for gluteal tendinopathy. Tendon problems at other sites follow similar principles, covered in chronic tendinopathy.
How Novo evaluates lateral hip pain
We examine first: where the pain is, what provokes it, hip motion, abductor strength, palpation and resisted testing, a lumbar screen, and any previous imaging or treatment. The aim is to work out whether the presentation looks like gluteal tendinopathy, another hip problem or referred pain, and to refer when the findings point elsewhere. See how we approach lateral hip pain and gluteal tendinopathy, or book a new patient exam.
References
- Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. American Journal of Roentgenology. 2013;201(5):1083-1086. PMID 24147479. (link)
- Kinsella R, Semciw AI, Hawke LJ, et al. Diagnostic accuracy of clinical tests for assessing greater trochanteric pain syndrome: a systematic review with meta-analysis. Journal of Orthopaedic and Sports Physical Therapy. 2024;54(1):26-49. PMID 37561820. (link)
- Ganderton C, Semciw A, Cook J, Pizzari T. Demystifying the clinical diagnosis of greater trochanteric pain syndrome in women. Journal of Women's Health. 2017;26(6):633-643. PMID 28263673. (link)
- Grimaldi A, Mellor R, Hodges P, et al. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine. 2015;45(8):1107-1119. PMID 25969366. (link)
- Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic and Sports Physical Therapy. 2015;45(11):910-922. PMID 26381486. (link)
