What is it?

Greater Trochanteric Pain Syndrome (GTPS) is a term used to highlight that lateral hip pain can come from a variety of sources. This includes, most commonly, gluteal tendinopathy, Iliotibial band syndrome, and trochanteric bursitis. This condition is common, especially in the 40-60 year-old age group. Initial therapies include oral medications, modification of physical activity, and physical therapy. If this fails, steroid injections can be performed to help treat the various conditions of GTPS. Another injections that could be recommended is platelet-rich plasma (PRP), which has been shown to be helpful for gluteal tendinopathy.

Prior to an injection your physician will review your medical history to ensure that these treatment options are safe. In particular they will want to know if you are diabetic, on blood thinners, currently ill, or have recent or healing fractures. Other considerations would be if you have had a joint replacement, bleeding disorders, or recent surgery.

Procedure Details

These procedures are normally done in the office. Some providers will choose to do them with ultrasound guidance to ensure that the medicine is placed around the correct structure and to further diagnose the exact cause of your pain. Patients are usually positioned in a side lying position with the painful hip up. The provider typically reviews the risks and benefits of the procedure prior to starting. The area to be injected will then be identified by the provider. Some providers use a local anesthetic, like lidocaine, to numb the area prior to injections, others choose to use ethyl chloride, which is a spray that “freezes” the skin, and some will perform the injection without anesthetic. The area is then injected and a band aid will be placed after the procedure. Most patients feel some burning and pressure at the site of the injection.

Post-Procedure Guidance

Patients will typically have numbness for a few hours until their anesthetic wears off and the steroid takes two days to two weeks to become maximally effective. For PRP it may be two to four weeks before the patient begins to have improvement. The patient may be asked to perform physical therapy depending on the procedure that was performed and the particular case. The patient should be aware of redness in the area of the injection, drainage, and pain out of proportion for 48 hours following the injection, which are signs of infection.

Side Effects

Anytime there is a break the skin with a needle there is a very small chance of infection. There will likely be a small amount of blood where the needle penetrates the skin. There is a very small chance that structures could be damaged by the needle, including the muscle and or tendon. Repeated steroids could potentially weaken tendons and muscles. There is also a risk that the patient could be allergic to steroids or there could be a reaction called a “steroid flare” to the medicine. All of these things are VERY RARE and in almost all cases the benefit of the injection will outweigh the concern of adverse effect.

AMSSM Member Authors
Cayce Onks, DO, MS, ATC

References
1. Bird P, Oakley S, Shnier R, Kirkham B. Prospective evaluation of Magnetic Resonance Imaging and Physical Examination Findings in Patients With Greater Trochanteric Pain Syndrome. Arth & Rheum. 2001;44(9): 2138-45.
2. Fitzpatrick J et. Al. The Effectiveness of Platlet-Rich Plasma Injections in Gluteal Tendinopathy. Am J Sport Med. 2018; 46(4): 933-39.
3. LaPorte C et. Al. Gluteus Medius Tears of the Hip: A Comprehensive Approach. Phys & Sport Med. 2019; 47(1): 15-20.