Greater trochanteric pain syndrome: defining the clinical syndrome
- Angela M Fearon1,2,
- Jennie M Scarvell1,2,3,
- Terry Neeman1,
- Jill L Cook5,
- Wes Cormick6,
- Paul N Smith1,2
- 1Department of Medicine, Biology and the Environment, ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
- 2Department of Surgery, Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- 3Faculty of Health, University of Canberra, Australian Capital Territory, Australia
- 4The Statistical Consulting Unit, The Australian National University, Canberra, Australian Capital Territory, Australia
- 5Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- 6Canberra Specialist Ultrasound, Canberra, Australian Capital Territory, Australia
- Correspondence to Dr Angela M Fearon Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel St, Robert Ho Research Centre, Vancouver, BC, Canada V5Z 1M9;
- Received 12 July 2012
- Accepted 14 August 2012
- Published Online First 14 September 2012
Background Effective treatment of hip pain improves population health and quality of life. Accurate differential diagnosis is fundamental to effective treatment. The diagnostic criteria for one common hip problem, greater trochanteric pain syndrome (GTPS) have not been well defined.
Purpose To define the clinical presentation of GTPS.
Methods Forty-one people with GTPS, 20 with hip osteoarthritis (OA), and 23 age-matched and sex-matched asymptomatic participants (ASC) were recruited. Inclusion and exclusion criteria ensured mutually exclusive groups. Assessment: the Harris hip score (HHS), a battery of clinical tests, and single leg stance (SLS). Participants identified the site of reproduced pain. Analysis: Fisher's exact test, analysis of variance (ANOVA) informed recursive partitioning to develop two classification trees.
Results Maximum walking distance and the ability to manipulate shoes and socks were the only HHS domains to differentiate GTPS from OA (ANOVA: p=0.010 and <0.001); OR (95% CI) of 3.47 (1.09 to 10.93) and 0.06 (0.00 to 0.26), respectively. The lateral hip pain (LHP) classification tree: (dichotomous LHP associated with a flexion abduction external rotation (FABER) test) had a mean (SE) sensitivity and specificity of 0.81 (0.019) and 0.82 (0.044), respectively. A non-specific hip pain classification tree had a mean (SE) sensitivity and specificity of 0.78 (0.058) and 0.28 (0.080).
Conclusions Patients with LHP in the absence of difficulty with manipulating shoes and socks, together with pain on palpation of the greater trochanter and LHP with a FABER test are likely to have GTPS.