Peritrochanteric Pain Syndrome

The peritrochanteric space is the region of the hip between the greater trochanter, a bony prominence at the top of the thigh bone, and the illiotibial band, a thick band of tissue that runs over the greater trochanter and down the side of the thigh. Peritrochanteric pain syndrome includes a cluster of disorders that cause severe pain on the side of the hip and thigh region.

They include:

• Snapping hip syndrome: slipping of the illiotibial band over the trochanter causing instability
• Greater trochanteric pain syndrome: chronic pain on the side of the hip over the region of the greater trochanter
• Gluteus tears: tears in the gluteus medius and minimus muscles (buttock muscles) due to injury or strain
• Trochanteric bursitis: inflammation of the bursae (fluid filled sacs that allow smooth motion between muscle and bone) around the greater trochanter

Trauma or repeated overuse of the tendons and muscles of the hip may result in friction between the structures causing inflammation and pain. Most of the conditions of peritrochanteric pain syndrome are more prevalent in women between the ages of 40 to 60, long distance runners, and in those with back pain, osteoarthritis and obesity.

Symptoms include chronic pain on the side of the hip that increases when lying down on the affected side, standing for a long time, climbing stairs and repeated movements involving the hip. Pain may radiate down the thigh, to the buttocks and/or below the knee. Snapping hip syndrome is also associated with a feeling or sound of snapping in your hip while walking, running, swinging your leg or getting up from a chair.

Peritrochanteric pain syndrome is diagnosed as you lie down with your affected side up, and experience tenderness as your doctor palpates a specific point over your hip and rotates the hip against resistance. Imaging tests such as the MRI give a detailed view of the bursa, muscles and tendons that may be affected.

Peritrochanteric pain syndrome is a self-limiting condition and can mostly be managed by conservative measures such as medication and physical therapy. If pain persists, your doctor may inject steroid and local anesthetic injections in the lateral hip and bursa areas. When non-surgical therapy does not relieve pain, surgical intervention may be recommended which may include minimally invasive arthroscopic surgery (use of a fiber-optic tube with a light and camera attached to clearly view the diseased region),bursa removal (bursectomy), release of the iliotibial band, gluteus medius repair and trochanteric osteotomy (reduction and repositioning of the greater trochanter).