Greater trochanteric pain syndrome

Place of trochanteric bursitis in the structure of dystrophic disorders

Greater trochanteric pain syndrome, more commonly referred to in clinical practice by the term trochanteric bursitis, represents a classic example of a reflex myosclerotomal syndrome. The essence of this pathological process lies in the development of inflammation, as well as concomitant dystrophy of connective tissue structures anatomically located in the area of the greater trochanter.

It is important to note that dystrophic changes in such conditions are rarely limited to a single location. Researchers include the following in this broad group of reflex myosclerotomal disorders:

• Knee epicondylitis.
• Various periarthropathies of the foot and ankle joint.
• Metatarsalgia.

Of particular clinical significance is the fact that dystrophy of the surrounding tissues in trochanteric bursitis can lead to mechanical entrapment of peripheral nerves of the lower limb. The consequence of such entrapment is the formation of secondary compression (tunnel) syndromes of the leg nerves, which requires thorough differential diagnosis.

Associated muscle-tonic syndromes

When considering the pathology of the greater trochanter, it is necessary to take into account the entire spectrum of muscle-tonic syndromes originating at the lumbosacral level of the spine. The key manifestations here include:

1. Thigh and leg muscle syndromes. These include muscle-tonic disorders in the hip abductors (the so-called "gluteal-tract syndrome"), adductor syndrome, as well as tonic disorders affecting the hamstring muscles and the tibialis anterior muscle.
2. Symphyseal and abdominal syndromes. This group includes abdominalgia syndrome, pubalgia, as well as specific "symphysis syndrome" and "symphysis-sternal syndrome".
3. Vertebrogenic iliopsoas syndrome.
4. Cramps. This term denotes extremely painful muscle spasms that can significantly worsen the course of the underlying disease and reduce the patient's quality of life.

Reflex angiopathic and biomechanical manifestations

In addition to structural changes in muscles and ligaments, the pathological process often involves the vascular bed, forming reflex angiopathic syndromes. Among them, leg vascular dystonia is distinguished, which can occur in two ways: either with a predominance of vasospasm or with the dominance of vasodilation.

The clinical picture may include local vasodystonias (both extravertebral compression and reflex), as well as general vasodystonias (vertebrogenic and reflex). More specific vascular manifestations include:

• Subpiriformis intermittent claudication syndrome.
• Restless legs syndrome.
• Peripheral artery occlusive disease syndrome of the legs.

At the level of general biomechanics of the musculoskeletal system, discogenic pathobiomechanical syndromes of the spine or other joints develop. They manifest through three main disorders: the emergence of persistent functional blocks, the development of regional postural muscle imbalance, and the fixation of a non-optimal motor stereotype.

Cervical reflex syndromes (for differential diagnosis)

For a comprehensive understanding of reflex processes in orthopedics, it is worth mentioning that non-compressive syndromes occur not only at the lumbar level. Reflex syndromes of cervical spine osteochondrosis are traditionally divided into two major categories: local vertebral syndromes and referred pain syndromes. Although they are localized in a different anatomical zone, the principles of their reflex development share common features with lower limb disorders.

Class and exam questions

What else to study on this topic

• Gluteal-tract syndrome and hip abductor disorders
• Secondary leg tunnel syndromes: mechanisms of nerve entrapment
• Subpiriformis intermittent claudication syndrome
• Regional postural muscle imbalance and non-optimal motor stereotype
• Symphyseal and abdominal syndromes (pubalgia, symphysis syndrome)

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.