What is trochanteritis?

Trochanteritis (Greater Trochanteric Pain Syndrome, GTPS) is inflammation and degeneration of the tendons of the gluteus medius and minimus muscles at their attachment to the greater trochanter of the femur, often accompanied by bursitis.

It is one of the most common causes of lateral hip pain. It occurs in 1.8–5.6 per 1,000 patients annually, predominantly in women over 40. It is often misdiagnosed as “hip osteoarthritis”.

Causes:

Tendinopathy — chronic overload of gluteus medius tendons
Muscle weakness — insufficiency of hip abductor muscles
Overload — running, prolonged walking, stair climbing
Biomechanics — leg length discrepancy, knee valgus
Trauma — fall on the side, contusion
Comorbidities — hip osteoarthritis, low back pain, scoliosis

Symptoms of trochanteritis

Typical symptoms

Pain on the outer surface of the hip
Pain when lying on the affected side (night pain)
Pain when climbing stairs
Pain when standing up after prolonged sitting
Point tenderness over the greater trochanter
Pain with resisted hip abduction

Key tests

Trendelenburg test — abductor weakness
FABER test — hip abduction in lateral position
Palpation of the greater trochanter — sharp tenderness
Pain when walking > 500 m

Why steroids are not the answer

Cortisone relieves pain for 4–12 weeks
Repeated injections weaken tendons
Risk of gluteus medius rupture increases
Recurrences become more frequent with each injection
Whether regenerative treatment is an option in this condition is assessed by the clinic doctor.

Diagnosing trochanteritis

Ultrasound

Dynamic ultrasound reveals thickening/inflammation of gluteus medius tendons, fluid in the bursa, and partial tendon tears. Allows real-time assessment.

MRI

Shows bone marrow oedema of the greater trochanter, tendinopathy/tendon tears, and bursa condition. Essential to rule out avascular necrosis and hip osteoarthritis.

X-ray

Rules out tendon calcifications and assesses hip joint condition. May show calcific trochanteritis.

Trochanteritis (greater trochanteric pain syndrome): treatment options and what is known about them

The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.

Option	What to expect	How well studied
Exercise therapy and physiotherapy	Reduces pain, strengthens muscles, improves function; the basis of treatment	Well studied, recommended
Load management, weight loss	Takes load off the affected area; if overweight, losing 5–10% noticeably reduces pain	Well studied, recommended
Shockwave therapy	A course of 3–5 sessions; helps some patients with chronic pain	Moderate evidence
Corticosteroid injection	Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable	Moderate evidence
PRP / CGF	Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown	Limited or conflicting evidence
Gluteal tendon surgery (rarely)	If conservative treatment does not help or there is an indication	When indicated — the doctor decides

We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.

Regenerative methods: realistic expectations

In tendinopathies the basis of treatment is graded loading of the tendon: specific exercises over 3–6 months. Shockwave therapy helps some patients. Evidence on PRP is conflicting: there are studies showing benefit in tennis elbow and plantar fasciitis, but no convincing evidence for other tendons. Corticosteroids relieve pain quickly, but the effect is often short, and repeated injections into a tendon are undesirable.

When surgery is discussed. Surgery is discussed for a complete tendon rupture or if pain persists for more than 6–12 months despite proper treatment.

If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.

Good to know: diagnosis, self-help, outlook

How to tell trochanteritis from similar conditions

Trochanteritis (greater trochanteric pain syndrome) is pain on the outer hip over the greater trochanter, most often in women over 40. It worsens when lying on the affected side, climbing stairs, standing on one leg and sitting with crossed legs. Hip osteoarthritis hurts in the groin and limits rotation, and radicular pain from the lower back comes with numbness below the knee. Ultrasound shows gluteal tendinopathy and the bursa.

What you can do yourself

Sleep on the healthy side with a pillow between the knees, do not cross your legs and do not “hang” on one hip when standing. Gradually strengthen the hip abductors. Stretches that pull the thigh across the midline are best avoided for a while, as they compress the tendon.

Outlook and timelines

An exercise programme gives a more lasting result than a corticosteroid injection, although the injection relieves pain faster. Shockwave therapy helps some patients with chronic pain. Surgery is rarely discussed — only for a confirmed tear of the gluteus medius tendons.

Who it is not suitable for and possible risks

Contraindications

Active infection — at the injection site or systemic, with fever.
Active cancer or ongoing chemotherapy.
Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
Pregnancy and breastfeeding — the procedure is usually postponed.
A corticosteroid injection into the same area in recent weeks.
Severe stage IV osteoarthritis with axial deformity and joint destruction — joint replacement is usually discussed instead.

Possible risks

Pain and swelling at the injection site for 1–3 days.
Bruising where blood or fat tissue is taken.
Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
The effect may be absent or smaller than expected.

If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.

Scientific evidence

Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:

Ye Y et al. Platelet rich plasma versus hyaluronic acid in patients with hip osteoarthritis: A meta-analysis of randomized controlled trials. Int J Surg, 2018.
Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019.

Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised

Frequently asked questions about trochanteritis treatment

Trochanteritis (greater trochanteric pain syndrome): can surgery be avoided?

In most cases yes: the basis is exercise and load management, sometimes shockwave therapy or injections. Only a minority of patients need surgery.

Trochanteritis (greater trochanteric pain syndrome): do PRP and cell-based methods help?

PRP may help some patients if exercise has not worked; the evidence depends on the tendon and is limited overall. Cell-based methods are poorly studied in tendinopathies.

When can I expect a result after an injection?

If an injection helps, relief usually builds up over 6–12 weeks. The result is assessed after 2–3 months; not everyone needs a repeat procedure. No clinic can guarantee a result.

Trochanteritis (greater trochanteric pain syndrome): when is surgery needed?

Surgery is discussed for a complete tendon rupture or if pain persists for more than 6–12 months despite proper treatment. The decision is made by the clinic doctor.

How does RegenPAS help organise treatment?

RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.

What is needed for a preliminary assessment?

Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.

How much does treatment cost and how long do I need to stay in Munich?

The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.

Treatment

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Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.

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