Tx and Followup:
Partial thickness tear can be treated with an injection of local anesthetic and corticosteroid. Ultrasound guidance is appropriate to locate area of tear, and injection itself should reproduce pain symptoms (both diagnostic and therapeutic in many cases). Gluteus medius injury and trochanteric bursitis can be treated with same methods.
NSAIDs are a useful adjunct, to help reduce local inflammation and swelling. Physical therapy is recommended to combat any atrophy that may have developed, and prevent future recurrence.
Full thickness tear, or retracted tear, is best treated with surgery to repair the deficit.
Greater trochanteric pain syndrome (GTPS) is characterized by local tenderness over the greater trochanter. The pain is exacerbated by standing, lifting, descending stairs, lying on the affected side and crossing the legs. The pain can radiate down the lateral length of the leg, and cause tenderness along the length of the ilio-tibial tract. The differential diagnosis of these physical findings include hip fracture, avascular necrosis, osteoarthritis, ilio-tibial band syndrome, infection of the joint and/or soft tissues of the hip, metastatic disease, and lumbosacral radiculopathy
Traditionally, the term GTPS was considered synonymous with trochanteric bursitis, and was treated with rest, injection and NSAIDs. More recently, several studies have identified pathology in the gluteus medius and minimus (the abductor tendons) as alternate causes of this pain, as identified on MRI and correlated with surgical findings. Findings include complete tears to mild tendonitis of the muscles at their insertion onto the greater trochanter. Studies have suggested that the bursitis may be secondary to abductor tendon pathology, prompting investigators to question the current treatment of the pain syndrome. Surgical intervention is recommended in the setting of a complete tear with retraction, while physical therapy and local injection at the affected tendon may be more appropriate for smaller tears and strains.
While local trauma has been identified as a cause of GTPS, there have been no cases in the literature describing a tear occurring during childbirth. Because this syndrome is currently undergoing some change in thought and approach to cause and treatment, perhaps it will be more readily identified as a cause of post-partum hip pain in the future.