Greater trochanteric pain syndrome (GTPS)

Definition/Description

Greater Trochanteric Pain Syndrome:

  • Age 40+ female > male
  • Likely good range of movements, non- capsular pattern
  • Possible painful resisted hip abduction
  • Cardinal sign: tenderness over the greater trochanter

 

MSK and CCG co-working on public health

  • Media campaign promoting positive lifestyle change and MSK health and role of regular activity for low grade joint symptoms.
  • Promotional materials at strategic locations
  • Appropriately targeted community initiatives
  • SEO of web hub

Red Flag Symptoms

None provided.

Guidelines on Management

Primary care

Patient presents to primary care with greater trochanteric pain syndrome
Primary care team to optimise pre MSK management using the MSK web hub for patient education and management or alternative offline resources.

Non- pharmacological management strategies:
Check BMI/ smoking/ exercise status: If lifestyle factors highlighted discuss as risk factors for MSK ill health/OA.
Refer to MSK web hub for lifestyle advice. Refer to MSK web hub for GTPS (condition directory)

Pharmacological management
Optimise medication management as per NICE guidelines. Consider topical NSAIDS, oral NSAIDs plus PPI, Paracetamol. Address any maladaptive beliefs around medication useage in conjunction with MSK web resource

Radiology:
Pelvic x ray can be useful if the site of pain is uncertain.
 

MSK physiotherapy 

Physiotherapy team to assist primary care in management of patients where web hub information and primary care strategies have not helped, where patients have self referred, or where patient is experiencing flair up.

All patients regardless of access point should have a discussion of expectations and functional goals to support planned management pathway.

Condition management:
1:1 treatment - this may include gluteus medius strengthening exercises and education

Offer joint injection if clinically appropriate with injection therapist
 

MSK extended scope practitioner

To support primary care and physiotherapy teams in managment and diagnosis of complex case presentations. To support patients in their decisions regarding surgery and ensure alternative treatment options have been explored and optimised.

Diagnostic uncertainty:
to utilise clinical skills and experience supported by diagnostic imaging and procedures to propose a primary diagnosis or diagnoses for patients with complex lower limb presentations or advanced disability.

Investigations
MRI useful if diagnostic uncertainty. USS guided injection can be considered - evidence to be updated.

Assurance of optimised conservative management:

To ensure conservative management pathways have been fully optimised for patients wincluding: medication, exercise, pacing, and lifestyle factors AND ensure expectations have been discussed.

Referral Criteria/Information

Onward referral options (following primary care):

Understand/manage expectations prior to referral- what are the goals of onward referral?

Condition management: MSK service- note patient must have engaged with online resources before making a condition management referral to MSK.

Lifestyle management: Consider local referral options- smoking cessation, weight management, HEAL programme.

Complex condition management: refer to MSK ESP team in cases of diagnostic uncertainty.
 

Onward referral options (following MSK physiotherapy):

Medication management: refer to primary care team or Physio independent prescriberi f medication optimisation required.

Lifestyle management: Consider local referral options- smoking cessation, weight management, HEAL programme, water based exercise oppertunities.

Complex condition management: refer to MSK ESP team in cases of diagnostic uncertainty or significant disability.
 

Onward referral options (following MSK extended scope practitioner):

Medication management: refer to primary care team or Physio independent prescriber if medication optimisation required.

Condition management: refer to MSK Physiotherapy team.

Lifestyle management: Consider local referral options- smoking cessation, weight management, HEAL programme.

Author:
Date created: 19/08/2025, 09:45
Last modified: 20/08/2025, 15:15
Date of review: ٣١‏/٧‏/٢٠١٩