Greater Trochanter Palpation | Gluteal Tendinopathy (GTPS)

Gluteal tendinopathy which falls under the nowadays used umbrella term greater trochanteric pain syndrome or GTPS is part of the differential diagnosis in patients with lateral hip pain.

Grimaldi et al. (2016) conducted a diagnostic accuracy study on different diagnostic tests that were contrasted to MRI findings indicative of gluteal tendinopathy. Palpation had a sensitivity of 80% and a specificity of 46,7%. This was the most sensitive test in the study and due to its negative likelihood ratio of 0.43, we give it a moderate clinical value in excluding gluteal tendinopathy.

Grimaldi et al. (2016) reference an article by Falvey et al. (2008) that describes a systematic approach to palpation of the structures around the greater trochanter. Viewing the greater trochanter as a ‘‘clock face’’, the muscles insert as follows: gluteus medius and its underlying bursa at 12, gluteus minimus and its underlying bursa at 1, gluteus maximus overlaps the area to insert from 2 to 6 with the vastus lateralis arising outside this. The Quadratus femoris insert between 7 and 8, the conjoint tendon of the gemelli and obturator internus at 8–10 and the rounded tendon of piriformis at 10–11.

The patient is going to lie on the unaffected side with the hips flexed to around sixty degrees and the knees together. Then proceed to palpate the structures around the greater trochanter and look for the reproduction of the patient’s lateral hip pain with palpation of the gluteus medius and or gluteus minimus tendon insertions. Pain felt should be at least 2/10 on the NPRS.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other  orthopedic tests that assess for gluteal tendinopathy are:

• Resisted External Derotation Test
• Single Leg Stance Test
• FADER / FADER-R / Modified Resisted External Derotation Test
• ADD / ADD-R/ Modified Ober’s Test

References

Lequesne, M., Mathieu, P., Vuillemin‐Bodaghi, V., Bard, H., & Djian, P. (2008). Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. Arthritis Care & Research, 59(2), 241-246.

Grimaldi, A., Mellor, R., Nicolson, P., Hodges, P., Bennell, K., & Vicenzino, B. (2017). Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain. British Journal of Sports Medicine, 51(6), 519-524.

Falvey, E. C., Franklyn-Miller, A., & McCrory, P. R. (2009). The greater trochanter triangle; a pathoanatomic approach to the diagnosis of chronic, proximal, lateral, lower pain in athletes. British journal of sports medicine, 43(2), 146-152.

Ganderton, C., Semciw, A., Cook, J., & Pizzari, T. (2017). Demystifying the clinical diagnosis of greater trochanteric pain syndrome in women. Journal of Women’s Health, 26(6), 633-643.