Cite This Article

Lee, V. Tomesch, A. Pain in the Buttt. Ortho Pearls. Nocember 27, 2024; Available: https://www.orthoempearls.com/articles/pain-in-the-butt

What is the diagnosis?

Greater Trochanteric Pain Syndrome (GTPS, also known as Trochanteric Bursitis). GTPS is a syndrome that is characterized by inflammation around the bursa sac that is just superior to the greater trochanter of the femur.(1,2) 

What is the mechanism of injury? What are the associated risk factors?

Although there is not one specific etiology that causes GTPS; repetitive irritation, trauma, previous surgeries, and/or even improper form when exercising can damage the bursa leading to bursitis [3]. Examples of repetitive movements that are commonly seen with patients diagnosed with GTPS include but are not limited to running, cycling, and jumping [3].

Although GTPS occurs over time through irritation and damage to the bursa, other risk factors can further increase your risk. Being a female, overweight, having a leg length discrepancy, scoliosis, Psoriasis, inflammatory arthritis like Gout, and/or diabetes can further increase your risk of developing GTPS [4]. 

How do you diagnose this?

The most classic physical finding in GTPS is point tenderness over the greater trochanter. Provocative maneuvers that exacerbate it include the Patrick-FABER test which is where a patient lies on their back and their hip is flexed, externally rotated, and abducted. Palpation around the GTB may also reproduce pain that radiates down the lateral thigh indicating tightness tightness around the tensor fascia latae [5]. Patients can often present with vague symptoms like low back pain, buttocks pain, or thigh pain and thus it is important to rule out other conditions. 

Which imaging modalities can be used?

Although plain radiographs can not visualize bursitis of the hip and femur, it is a great adjunct in evaluating other etiologies of pain such as underlying osteoarthritis, bony lesion, degenerative arthritis, and/or structural abnormalities.

Image 2: Image courtesy of Roberto Schubert, www.radiopaedia.org, rID: 18199

MRI on the other hand which can be done, but not usually performed, in the outpatient setting would typically show an increased signal in bursa due to inflammation on T2 sequence. Please refer to Image 2 [6]. 

Image 3: Image courtesy of James Harvey, radiopaedia.org, rID: 82181

Ultrasound can also be used to evaluate for fluid pockets. Image 3 above shows a distended combination of anechoic and hypoechoic fluid [7]. 

What is the management in the ED and outside the ED?

The main management in the ED setting would be to rule out anything else that could be contributing to pain and by providing pain relief mainly in the form of NSAIDS. As long as there are no alarm symptoms such as focal weakness, sensory changes, and are able to bear weight they can follow up with their primary care provider plus or minus physical therapy with a few day prescription of OTC pain relievers like ibuprofen, naproxen or acetaminophen. 

• Pearl: Corticosteroid injections can be used to help further decrease inflammation and provide pain relief if not improved with conservative measures.