Original article
Greater Trochanteric Pain Syndrome: Epidemiology and Associated Factors

https://doi.org/10.1016/j.apmr.2007.04.014Get rights and content

Abstract

Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, Nevitt MC, for the Multicenter Osteoarthritis (MOST) Study Group. Greater trochanteric pain syndrome: epidemiology and associated features.

Objectives

To describe the prevalence of greater trochanteric pain syndrome (GTPS); to determine whether GTPS is associated with iliotibial band (ITB) tenderness, knee osteoarthritis (OA), body mass index (BMI), or low back pain (LBP); and to assess whether GTPS is associated with reduced hip internal rotation, physical activity, and mobility.

Design

Cross-sectional, population-based study.

Setting

Multicenter observational study.

Participants

Community-dwelling adults (N=3026) ages 50 to 79 years.

Interventions

Not applicable.

Main Outcome Measures

Greater trochanteric tenderness to palpation in subjects with complaints of hip pain and no signs of hip OA or generalized myofascial tenderness.

Results

The prevalence of unilateral and bilateral GTPS was 15.0% and 8.5% in women and 6.6% and 1.9% men. Odds ratio (OR) for women was 3.37 (95% confidence interval [CI], 2.67−4.25), but age and race were not significantly associated with GTPS. In a multivariate model, adjusting for age, sex, ITB tenderness, ipsilateral and contralateral knee OA, BMI, and LBP, ITB tenderness (OR=1.72; 95% CI, 1.34−2.19), knee OA ipsilaterally (OR=3.47; 95% CI, 2.72−4.42) and contralaterally (OR=1.74; 95% CI, 1.32−2.28), and LBP (OR=2.79; 95% CI, 2.22−3.50) were positively related to GTPS. In this complete model, BMI was not associated with GTPS (OR=1.10; 95% CI, 0.80−1.52 when comparing   30 with <25kg/m2). Hip internal rotation range of motion did not differ based on GTPS status. After multivariate adjustment, GTPS did not alter physical activity score, but bilateal GTPS was significantly associated with a higher 20-meter walk time and chair stand time.

Conclusions

The higher prevalence of GTPS in women and in adults with ITB pain or knee OA indicates that altered lower-limb biomechanics may be related to GTPS. Slower functional performance in those with GTPS suggests that the study of targeted rehabilitation may be useful. A longitudinal study will be necessary to identify causal factors and outcomes of interventions.

Section snippets

Participants

The Multicenter Osteoarthritis (MOST) Study is a longitudinal study of persons 50 to 79 years old at a high risk of developing symptomatic knee OA or who already had knee OA. Subjects are drawn from the community. Although the purpose of the MOST study is to assess risk factors for incident and progressive knee OA, the availability of standardized data on GTPS diagnosis and associated features in a large community-based sample makes it a useful resource for analysis. The present report uses

Prevalence of GTPS

A total of 5735 lower limbs from 2954 subjects were eligible for analysis of GTPS (fig 1). The subjects’ mean age ± SD was 62.4±8.1 years, and 60.1% were women. Of these subjects, 517 (17.6%) had GTPS. Specifically, 344 had unilateral and an additional 173 had bilateral GTPS, a prevalence of 11.7% and 5.9%, respectively (table 1). The prevalence of unilateral and bilateral GTPS was 15.0% and 8.5% in women and 6.6% and 1.9% in men. Comparing subjects with and without GTPS, the OR for GTPS in

Discussion

This study was useful in both identifying the prevalence of GTPS in a non-clinic–based population as well as assessing the validity of common teachings regarding GTPS. The GTPS prevalence of 17.6% in this community-based sample of older adults at high risk of knee OA contrasts with the 20% to 35% reported for spine clinic patients presenting with LBP. We found the following were associated with GTPS: female sex, ITB tenderness, knee OA or knee pain, and LBP.

Reasons for the differences in

Conclusions

The higher prevalence of GTPS in people who report hip pain in the absence of knee or generalized pain (24% of women, 9% of men) indicates that GTPS is common, and greater clinical awareness may identify patients for primary prevention and therapy. Slower functional performance in those with GTPS suggests that the study of targeted rehabilitation may be useful to minimize the impact of GTPS. A longitudinal study will be necessary to identify causal factors and outcomes of interventions.

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    Supported by the National Institute of Child Health and Human Development, National Institutes of Health (grant no. 5K12HD001097-08) and National Institute on Aging, National Institutes of Health (grant nos. 1 U01 AG18832, 1 U01 AG18820, 1 U01 AG19069, 1 U01 AG18947).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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