Pain over the outside of the hip, particularly when you are lying on your side or trying to sleep at night, is commonly related to the tendons that join the gluteal muscles to the hip, and of the nearby bursae, which are fluid-filled sacks that help reduce friction between tendons and bones.
These lateral hip conditions can be difficult to differentiate in regards to their symptoms and may be diagnosed as gluteal tendinopathy, trochanteric bursitis or Greater Trochanteric Pain Syndrome (GTPS) which encompasses both.
Regardless of whether it is the tendons or bursae that are most affected, the underlying cause is often the same and the methods used to manage these conditions will benefit both structures.
What are the symptoms of gluteal tendinopathy and trochanteric bursitis?
The main symptom of both these lateral hip conditions is pain and tenderness over the bony prominence at the side of the hip. This is known as the greater trochanter. This pain may then spread down the outer side of the thigh to the knee. Patients usually find pain worsens at night and disturbs their sleep. Pain often will begin to affect their activity levels and make walking uphill or up the stairs or getting up from chairs more challenging.
Who is most prone to developing gluteal tendinopathy and trochanteric bursitis?
Many factors can affect the health of the tendons and bursa on the outside of the hip, including too much activity and not enough. Overuse and tissue overload may contribute to developing symptoms. A sedentary lifestyle plus weight gain or obesity may also exacerbate symptoms. Hormonal changes are thought to contribute to tendon changes and women are three times more likely to develop Greater Trochanteric Pain Syndrome (GTPS).
Once pain and discomfort start to present, patients often tend to adopt poor postures or movement patterns to compensate and that also contributes to a worsening of symptoms.
What are the treatment options for gluteal tendinopathy and trochanteric bursitis?
Physiotherapy targeting the lateral hip muscles is the first stage and usually effective at managing these conditions. Cortisone or corticosteroid injections can be helpful to reduce pain while embarking on a progressive strengthening program.
Surgery is not typically recommended and only considered if conservative management has failed. It can include gluteal tendon repair, removal of the bursa, and removal of the bone underlying the tendon.
Mr Sulaiman Alazzawi is a Consultant Orthopaedic and Trauma Surgeon based at St Georges University Hospital and the South West Elective Orthopaedic Centre in Epsom. He specialises in hip and knee replacements and treating painful or failing joint replacements. His private practice is based at Fortius Clinic and Parkside Hospital in Wimbledon and Spire St Anthony’s Hospital in Sutton.
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