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Joint vs. Muscle: Understanding the Difference Between Hip Osteoarthritis and Greater Trochanteric Pain

Writer's picture: Luke SchembriLuke Schembri

Hip pain is a common complaint, particularly among middle-aged and older adults. Two conditions that frequently cause hip pain are Hip Osteoarthritis (OA) and Greater Trochanteric Pain Syndrome (GTPS). Although these conditions share some similarities in terms of symptoms, they have different underlying causes, treatment approaches, and long-term outcomes. Understanding the differences between Hip OA and GTPS is crucial for accurate diagnosis and effective management. This blog will explore the distinctions between these two conditions, focusing on their signs and symptoms, underlying pathology, and treatment options.


woman with hip pain

What is Hip Osteoarthritis?

Hip osteoarthritis is a degenerative joint disease characterised by the aged-related change that occurs to the cartilage in the hip joint. The hip is a ball-and-socket joint, with the ball (femoral head) fitting into the socket (acetabulum) of the pelvis. The cartilage that covers these surfaces allows for smooth movement, but over time, it can reduce and, in some cases, significantly. This can cause pain, stiffness, and decreased joint function.


Signs and Symptoms of Hip Osteoarthritis:

woman with hip osteoarthritis
  • Pain in the Groin or Thigh: The most common symptom of hip OA is pain located deep in the groin, buttock, or thigh. This pain typically worsens with activity and improves with rest.

  • Stiffness: Hip stiffness, especially after periods of inactivity such as sleeping or sitting, is a hallmark of hip OA. Morning stiffness lasting for less than 30 minutes is common.

  • Reduced Range of Motion: As the condition progresses, patients may notice a decrease in the hip's range of motion, making it difficult to perform everyday activities such as putting on socks or shoes.

  • Crepitus: A grinding or clicking sensation during hip movement may occur due to the rough surfaces of the joint.

  • Functional Limitations: Patients with hip OA often have trouble with weight-bearing activities, such as walking, climbing stairs, or standing up from a seated position.


What is Greater Trochanteric Pain Syndrome?

Greater Trochanteric Pain Syndrome (GTPS) is a condition that causes pain over the lateral aspect of the hip, specifically around the greater trochanter, the bony prominence on the outside of the hip. Unlike hip OA, which involves the hip joint itself, GTPS is primarily related to the soft tissues surrounding the hip, including the gluteal tendons and the bursa (fluid-filled sacs that reduce friction between tendons and bones).


Signs and Symptoms of Greater Trochanteric Pain Syndrome:

gluteal stretch
  • Lateral Hip Pain: The primary symptom of GTPS is pain over the outer hip, which may radiate down the outer thigh. This pain is often exacerbated by lying on the affected side, walking, standing for prolonged periods, sitting in low chairs and cross legged or climbing stairs.

  • Tenderness over the Greater Trochanter: Palpation of the greater trochanter typically elicits tenderness, and this is often the most prominent clinical finding in GTPS.

  • Pain with Activity: Activities involving repetitive hip movements, such as running or prolonged standing, can aggravate the pain associated with GTPS. Generally, it does not like being put on stretch.

  • Night Pain: Patients often report pain at night, particularly when lying on the affected side, which can disrupt sleep.

  • Muscle Weakness: Some patients with GTPS may experience weakness in the hip abductor muscles, particularly the gluteus medius and minimus, which can affect gait and mobility.


Key Differences Between Hip Osteoarthritis and Greater Trochanteric Pain Syndrome

While both Hip OA and GTPS cause hip pain, there are several key differences between the two conditions, however, it is important to note they can occur concurrently:


1. Location of Pain

  • Hip OA: The pain in hip OA is typically located deep in the groin, buttock, or thigh. It may radiate to the knee or lower back but is primarily centred around the hip joint itself.

  • GTPS: In contrast, the pain in GTPS is localised to the lateral aspect of the hip, specifically over the greater trochanter. This pain may radiate down the outer thigh but does not typically affect the groin or inner thigh, although can refer in this direction.


2. Underlying Pathology

  • Hip OA: Hip OA is a degenerative joint disease involving change to the articular cartilage within the hip joint. Over time, the joint surfaces lack their smooth articular surface, leading to pain, stiffness, and decreased range of motion.

  • GTPS: GTPS is a soft tissue condition involving inflammation or degeneration of the gluteal tendons and bursa around the greater trochanter. It is often associated with tendinopathies, particularly of the gluteus medius and minimus muscles.


3. Risk Factors

  • Hip OA: Risk factors for hip OA include aging, obesity, a history of hip injury/surgery or trauma, genetic predisposition, and certain occupations or sports that involve repetitive hip loading.

  • GTPS: GTPS is more common in women, particularly those who are peri- or post-menopausal. Hormonal changes during menopause can affect tendon health, increasing the risk of tendinopathies. Additionally, GTPS is often associated with altered biomechanics, such as increased load on the hip due to changes in gait or muscle weakness.


4. Impact of Hormones on Soft Tissue Health

One reason GTPS is more common in peri- and post-menopausal females is the impact of hormonal changes on soft tissue health. Oestrogen plays a critical role in maintaining the strength and elasticity of tendons and ligaments. As oestrogen levels decline during menopause, the tendons become more susceptible to degeneration and injury, leading to conditions like GTPS.


In contrast, while hormonal changes can influence the development of OA, the primary drivers of hip OA are mechanical factors and cartilage degradation rather than soft tissue changes.

pelvic floor health

5. Management and Treatment


Hip Osteoarthritis:

  • Exercise and Physiotherapy: Regular exercise, particularly low-impact activities if higher impact activities are too sore, like swimming or cycling, can help maintain joint mobility and muscle strength. Physiotherapy is often recommended to improve flexibility and reduce pain.

  • Weight Management: Reducing body weight can alleviate stress on the hip joint, slowing the progression of OA.

  • Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage pain and inflammation in hip OA. Opioids are generally not recommended for OA pain.

  • Joint Injections: Corticosteroid injections may be used to provide temporary pain relief and need to be completed under ultrasound guidance. They can also be used as a diagnostic tool in more complex cases. For example, when there is pain in the lower back and hip and it is difficult to establish source of symptoms.

  • Surgery: In severe cases, total hip replacement surgery may be necessary to relieve pain and restore function.

    hip strength exercises

Greater Trochanteric Pain Syndrome:

  • Activity Modification: Patients are advised to reduce and adapt activities that exacerbate their symptoms, such as lying on the affected side, prolonged standing or weight bearing activities like walking and running.

  • Physiotherapy: Physiotherapy is a key component of GTPS management, focusing on strengthening the hip abductor muscles and improving flexibility.

  • Shockwave Therapy: Extracorporeal shockwave therapy (ESWT) has been shown to be effective in some patients with GTPS, promoting tissue healing and reducing pain.

  • Corticosteroid Injections: For patients who do not respond to conservative treatment, corticosteroid injections into the trochanteric bursa can provide temporary relief by reducing inflammation.

  • Surgery: Surgical intervention is rarely required for GTPS but may be considered in severe or refractory cases.

    physiotherapy for hip pain

Conclusion

Hip Osteoarthritis and Greater Trochanteric Pain are two distinct conditions that cause hip pain but have different underlying causes, symptoms, and treatment approaches. Hip OA is a degenerative joint condition primarily affecting the cartilage within the hip joint, while GTPS is a soft tissue condition involving the tendons and bursa around the greater trochanter. Understanding the differences between these conditions is crucial for accurate diagnosis and effective management. For individuals experiencing hip pain, consulting with a healthcare professional is essential to determine the underlying cause and develop an appropriate treatment plan.


References

  1. NICE guidelines [CG177]: Osteoarthritis: care and management. National Institute for Health and Care Excellence. (2014).

  2. Fearon, A. M., Cook, J. L., & Scarvell, J. M. (2014). Greater trochanteric pain syndrome: defining the syndrome. British Journal of Sports Medicine, 48(10), 647-653. doi:10.1136/bjsports-2012-091565.

  3. Arden, N. K., & Nevitt, M. C. (2006). Osteoarthritis: epidemiology. Best Practice & Research Clinical Rheumatology, 20(1), 3-25. doi:10.1016/j.berh.2005.09.007.

  4. Rompe, J. D., Segal, N. A., Cacchio, A., Furia, J. P., Morral, A., & Maffulli, N. (2007). Home training, local corticosteroid injection, or radial shockwave therapy for greater trochanter pain syndrome. The American Journal of Sports Medicine, 37(10), 1981-1990. doi:10.1177/0363546509335544.

  5. Zhang, W., Nuki, G., Moskowitz, R. W., Abramson, S., Altman, R. D., Arden, N., ... & Doherty, M. (2010). OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage, 18(4), 476-499. doi:10.1016/j.joca.2010.01.026.






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