Changes

September 2026 — reviewed. A literature search was conducted in September 2026 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The recommendations on management have been updated to recommend education on load management and a structured exercise programme as first-line treatment, with peri-trochanteric corticosteroid injection reserved for short-term pain relief alongside exercise, in line with new systematic reviews and an international consensus statement. 

Update

Goals

To support primary healthcare professionals to:

• Make a diagnosis of greater trochanteric pain syndrome.
• Initiate appropriate primary care management.
• Refer to secondary care when appropriate. 

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic. 

NICE quality standards

No NICE quality standards were found during the review of this topic.

What is it?

• Greater trochanteric pain syndrome is a regional pain syndrome in which chronic intermittent pain is felt around the greater trochanter (the bony prominence on the lateral aspect of the hip).
  • It is an umbrella term encompassing a spectrum of conditions affecting the peritrochanteric space, including gluteal tendinopathy (gluteus medius and minimus), gluteal tendon tears, trochanteric bursitis, and external snapping hip (coxa saltans).
• Trochanteric bursitis is inflammation of a bursa adjacent to the greater trochanter.
  • Bursae are sacs lined with synovial membrane that lie over bony prominences and allow muscles, tendons, and fascia to move freely. Although most people have three bursae around the greater trochanter, up to twenty bursae have been identified.
• The term 'trochanteric bursitis' was previously used to refer to what is now known as 'greater trochanteric pain syndrome'. The inclusive term 'greater trochanteric pain syndrome' is preferred as the trochanteric bursae play a smaller role than was previously thought, and inflammation is not always present.

[Reid, 2016; Pianka, 2021; Sunil Kumar, 2021; Gill, 2025]

What causes it?

• Greater trochanteric pain syndrome is caused by degeneration, inflammation or physical trauma in muscles (gluteus maximus, medius, minimus, or piriformis), tendons, fascia, or bursae around the greater trochanter. The most common causes are:
  • Tendinopathy/muscular tear of the gluteus medius.
  • Tendinopathy/muscular tear of the gluteus minimus.
  • Trochanteric bursitis. 
• Gluteal tendinopathy is now considered to be the primary pathology in most people, and isolated bursitis without tendon involvement is uncommon. Bursitis and tendinopathy frequently co-exist.
  • The anterolateral part of the gluteus medius tendon is thought to be more prone to tears because its tendinous portion is thin.
  • Compression of the gluteal tendons against the greater trochanter by the iliotibial band, particularly in positions of hip adduction, is thought to contribute to tendon degeneration.
• Other causes include:
  • Iliotibial band thickening. 
  • External snapping hip, caused by the iliotibial band or gluteus maximus catching over the greater trochanter 
  • Infection of the trochanteric bursa (septic bursitis) is a rare cause of greater trochanteric pain syndrome. Septic bursitis most commonly affects superficial bursae such as the olecranon and prepatellar bursae, and is usually caused by Staphylococcus aureus. 

[Reid, 2016; Lormeau, 2019; Pianka, 2021; Sunil Kumar, 2021; Lespasio, 2022; Disantis, 2023; Gill, 2025]

What conditions are associated with greater trochanteric pain syndrome?

• Greater trochanteric pain syndrome frequently occurs together with other conditions:
  • Lumbar spine conditions, such as osteoarthritis, degenerative disc disease, and radiculopathy.
  • Osteoarthritis (OA) of the knee, especially on the affected side.
  • Hip osteoarthritis (on the affected or unaffected side) — approximately two-thirds of people with greater trochanteric pain syndrome have co-existing hip joint osteoarthritis or low back pain.
  • Rheumatoid arthritis.
  • Fibromyalgia.
  • Iliotibial band (ITB) tenderness.
• Risk factors associated with greater trochanteric pain syndrome include:
  • Female sex — possibly related to a wider pelvis and differences in hip biomechanics.
  • Age 40–60 years.
  • Obesity.
  • Leg length discrepancy.
  • Reduced hip abductor muscle strength.

[Reid, 2016; Plinsinga, 2019; Pianka, 2021; Lespasio, 2022]

How common is it?

• Greater trochanteric pain syndrome affects approximately 1.8–5.6 people per 1000 per year.
• It is more prevalent in women aged 40–60 years, but it can occur in younger people, especially runners, footballers, and dancers.
• It accounts for an estimated 10–20% of presentations with hip pain in primary care.
• Gluteal tendinopathy is particularly common in postmenopausal women and has a significant impact on physical function and quality of life.
• Greater trochanteric pain syndrome is the most common cause of lateral hip pain in adults.

[Reid, 2016; Speers, 2017; Pianka, 2021; Grimaldi, 2024; Fearon, 2025]

What is the prognosis?

• Greater trochanteric pain syndrome is usually a self-limiting condition and resolves in over 90% of people with conservative treatment such as rest, analgesia, physiotherapy, and corticosteroid injection. 
  • A few cases persist despite treatment and time — these refractory cases may require surgical intervention (for example, bursectomy, iliotibial band [ITB] lengthening techniques, or gluteal tendon repair).
  • Symptoms may persist for many months — in one trial included in a narrative review, 60.5% of people treated with physiotherapy reported symptom resolution at 15 months.
• A systematic review that summarized the evidence for generic prognostic factors across a range of musculoskeletal conditions, regardless of pain site, identified the following factors associated with poorer outcomes: 
  • High pain intensity.
  • Long pain duration.
  • Widespread pain.
  • High functional disability.
  • Presence of previous pain episodes.
  • Somatization.
  • Movement restriction.
  • Depression/anxiety.
  • Poor coping strategy.

[Reid, 2016; Artus, 2017; Disantis, 2023; Gill, 2025]

What are the signs and symptoms of greater trochanteric pain syndrome?

• Greater trochanteric pain syndrome typically presents as chronic lateral hip, thigh, or buttock pain, which can be intermittent or persistent.
  
  • The onset is usually gradual and may progressively worsen over time.
  • Pain may radiate down the lateral aspect of the thigh, but rarely below the knee.
• The pain is typically aggravated by:
  • Physical activity, particularly single-leg weight-bearing activities such as walking, climbing stairs, or standing on one leg.
  • Pressure on the affected side (for example, when lying on that side at night), which may disturb sleep.
  • Positions of hip adduction, such as sitting with the legs crossed or standing with the weight shifted onto one hip.
• There is pain on palpation of the greater trochanter. 

How should I assess suspected greater trochanteric pain syndrome?

The diagnosis of greater trochanteric pain syndrome is made on clinical grounds: 

• Ask about:
  • The signs and symptoms, including the location (anterior groin, buttock, lateral hip, lower back, or anterior thigh), radiation, nature and onset of pain, and what aggravates or relieves it (for example, lying on the affected side, climbing stairs, or standing or sitting for extended periods).
  • Occupational, daily, and sporting activities, and whether this activity has been increased or decreased recently. 
  • History of trauma or previous hip-related conditions or surgery. 
  • Medication use, including corticosteroids.
• Conduct a neuromusculoskeletal examination.
  • Palpate the greater trochanter — tenderness is typically elicited at a point over the gluteus medius tendon or its insertion into the greater trochanter.
    • If palpation is positive, carry out a resisted hip abduction test. If both tests are positive, greater trochanteric pain syndrome is highly likely; if both are negative, it is unlikely.
  • Observe for an abnormal gait.
    • Antalgic gait — there is a shortened stance on the affected leg, and when walking, less time is spent bearing weight on the affected side than on the other. 
    • Trendelenburg gait — there is a lateral trunk lean towards the supported limb during the stance phase. 
  • Conduct a physical examination of the hip — there is often pain on resisted active abduction, resisted internal rotation, and/or resisted external rotation of the hip joint on the affected side.
• Check for associated conditions such as lumbar spine conditions and arthritis of the hip or knee. 
• Exclude other conditions with presentations similar to that of greater trochanteric pain syndrome.
  • Arrange a plain radiograph of the hip if there is any suspicion of acute fracture, dislocation, stress fracture, or significant hip osteoarthritis.
• Imaging is not routinely required to diagnose greater trochanteric pain syndrome. Findings on ultrasound or magnetic resonance imaging (MRI), such as tendinopathy and bursitis, are common in people without symptoms and correlate poorly with symptoms.
  • If imaging is needed to exclude other causes of hip pain, plain radiography of the hip and pelvis is the initial test of choice.
• Exclude any underlying infection of the bursae.
  • A tender palpable mass, redness, oedema, or warmth around the lateral hip would suggest possible infection.

Differential diagnosis

Conditions that can present similarly to greater trochanteric pain syndrome include:

• Soft-tissue conditions
  • Iliotibial band/snapping hip syndrome
    • History: lateral hip pain on walking, running, or cycling, with or without snapping; lateral knee pain aggravated by repetitive activity.
    • Examination: symptoms can be reproduced by adducting the hip joint while it is held in extension and external rotation (Ober's test).
  • Iliopsoas bursitis 
    • History: reproducible painful snapping sensations in the anterior hip.
    • Examination: tenderness on deep palpation over the femoral triangle (upper inner thigh).
  • Sports hernia/athletic pubalgia/Gilmore's groin 
    • History: dull, diffuse pain radiating to the inner thigh. Pain with direct pressure, sneezing, sit-ups, kicking, or Valsalva manoeuvre.
    • Examination: no hernia, tenderness of the inguinal canal or pubic tubercle, adductor origin, pain with resisted sit-up or hip flexion.
• Joint and bone conditions
  • Arthritis  
    • History: gradual onset of pain in the hip or groin that is made worse by weight bearing and relieved by prolonged rest. Pain may be referred to the anterior or lateral hip, groin, and around the knee.
    • Examination: the range of motion of the hip joint is limited by pain, especially on internal rotation with the hip and knee flexed; there is usually an antalgic gait (limp in which less time is spent bearing weight on the affected side).
    • For more information, see the CKS topics on Ankylosing spondylitis, Osteoarthritis, and Rheumatoid arthritis.
  • Avascular necrosis of the femoral head
    • History: gradual onset of dull ache in the groin, thigh, and buttock; history of use of corticosteroids or alcohol misuse (although these risk factors are often not present).
    • Examination: the range of movement of the hip joint is restricted only in advanced stages of avascular necrosis.
    • Tests: the diagnosis is confirmed radiologically — in its early stages, avascular necrosis of the femoral head will be shown on magnetic resonance imaging, but not on X-ray. 
  • Fracture of the femoral neck 
    • History: associated with acute trauma or repetitive weight-bearing exercise, deep, referred pain with weight-bearing, worse with activity. 
    • Examination: pain may be present with extremes of motion, active straight leg raise, leg roll test, or hopping, and palpation of the greater trochanter. 
  • Sacroiliac joint dysfunction  
    • History: pain over the posterior buttock, radiating to the buttock, groin, and posterior proximal thigh.
    • Examination: pain when the sacroiliac joint is stressed, for example, with the sacroiliac (posterior) shear test.
  • Hip impingement syndrome  
    • History: pain in the groin and hip area related to sporting activity.
    • Examination: pain or restriction of movement when the hip joint is flexed or rotated internally.
• Neurological conditions
  • Meralgia paraesthetica (entrapment of the lateral femoral cutaneous nerve)
    • History: numbness, tingling (paraesthesia), and burning pain in the distribution of the nerve (anterolateral hip and thigh to just above the knee), which is aggravated by walking and by extension of the hip joint; recent gain in weight.
    • Examination: symptoms may be reproduced by pressure over the lateral femoral cutaneous nerve. A more accurate test, especially in people who are overweight, may be pinprick sensation over the lateral aspect of the thigh.
  • Lumbar radiculopathy  
    • History: leg numbness, paraesthesia, and pain radiating below the knee; often accompanied by low back pain.
    • Examination: symptoms can be reproduced by the straight leg raising test or by the femoral nerve stretch test.
    • For more information, see the CKS topic on Sciatica (lumbar radiculopathy).
  • Deep gluteal syndrome (sciatic nerve entrapment in the deep gluteal space).
    • History: buttock pain, which may radiate down the back of the thigh, often worse with prolonged sitting.
    • Examination: tenderness in the buttock rather than over the greater trochanter.
  • Lumbar spinal stenosis
    • History: buttock and leg pain, often bilateral, brought on by walking or prolonged standing and relieved by sitting or bending forward (neurogenic claudication).
    • Examination: there may be few physical signs; lateral hip tenderness is not typical.

Scenario: Management

From age 16 years onwards.

Search strategy

Scope of search

A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on primary care management of greater trochanteric pain syndrome.

Search dates

April 2021 - September 2026

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

• *Bursitis/
• exp hip joint/
• lateral hip pain.kw
• greater trochanteric pain.kw
• trochanteric bursitis.kw
• (tronchanteric adj bursitits).ti,ab.
• (“greater trochanteric bursitis” or GTBS) adj (pain or syndrome$).ti,ab.
• (corticosteroid adj injection$).ti,ab.
• *adrenal cortex hormones/ (synonym corticosteroids)

Sources of guidelines

• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Royal College of Physicians
• Royal College of General Practitioners
• Royal College of Nursing
• NICE Evidence
• World Health Organization
• Guidelines International Network
• TRIP database
• Agency for Healthcare Research and Quality
• National Health and Medical Research Council (Australia)
• Royal Australian College of General Practitioners
• British Columbia Medical Association
• Canadian Medical Association
• Alberta Medical Association
• Michigan Quality Improvement Consortium
• Singapore Ministry of Health
• National Resource for Infection Control
• RefHELP NHS Lothian Referral Guidelines
• Medline (with guideline filter)
• Driver and Vehicle Licensing Agency
• NHS Health at Work (occupational health practice)

Sources of systematic reviews and meta-analyses

• The Cochrane Library:
  • Systematic reviews
  • Protocols
  • Database of Abstracts of Reviews of Effects
• Medline (with systematic review filter)
• EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

• NIHR Health Technology Assessment programme
• The Cochrane Library:
  • NHS Economic Evaluations
  • Health Technology Assessments
• Canadian Agency for Drugs and Technologies in Health
• International Network of Agencies for Health Technology Assessment

Sources of randomized controlled trials

• The Cochrane Library:
  • Central Register of Controlled Trials
• Medline (with randomized controlled trial filter)
• EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

• Drug and Therapeutics Bulletin
• TRIP database
• Central Services Agency COMPASS Therapeutic Notes

Sources of national policy

• Department of Health
• Health Management Information Consortium (HMIC)

Patient experiences

• Healthtalk
• BMJ - Patient Journeys

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

• British National Formulary (BNF)
• electronic Medicines Compendium (eMC)
• European Medicines Agency (EMEA)
• Medicines and Healthcare products Regulatory Agency (MHRA)
• REPROTOX
• Scottish Medicines Consortium
• Stockley's Drug Interactions
• TERIS
• TOXBASE
• Micromedex
• UK Medicines Information

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Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

• Clinical accuracy.
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Evidence exclusion criteria

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Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

• Animal studies
• Original research is not written in English

Possible exclusions for reviewed literature:

• Sample size too small or study underpowered
• Bias evident or promotional literature
• Population not relevant
• Intervention/treatment not relevant
• Outcomes not relevant
• Outcomes have no clear evidence of clinical effectiveness
• Setting not relevant
• Not relevant to UK
• Incorrect study type
• Review article
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Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

• Feasibility
  • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
• Organizational and Financial Impact Analysis
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  • Time dependencies
• Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

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Competing interests declared for this topic:

None.