Trochanteric Bursitis

Historically, the condition of pain and tenderness in the area of the greater trochanter had been referred to as trochanteric bursitis. Recent literature has referred to this condition as greater trochanteric pain syndrome. This change has come about owing to the recognition that the etiology of this pain can be from multiple sources that include the bursae in the area but also can include tendinosis or tendinopathy. These include the tendons of the gluteus medius and gluteus minimus that insert on the greater trochanter (1,2,3,4,5,6,7).

Bursitis refers to inflammation of the bursae.

Tendinosis refers to chronic degenerative changes within the tendon.

Tendinopathy refers to any anomaly of a tendon. This can include inflammation or degeneration.

More common in adults

Incidence peaks between the 4th and 6th decades of life.

Predominant gender: Female > Male (4:1)

Common in runners

Ipsilateral or contralateral hip arthritis

Degenerative changes of the lumbar spine

Degenerative changes of the knees

Leg-length discrepancy

Total hip arthroplasty

Obesity

Fibromyalgia

Iliotibial band syndrome

Weakness of hip abductors and/or external rotators of the hip

Pes planus

Excessive or rapidly increased activity

Training on hard or banked surfaces

Poorly cushioned shoes

Limitation of internal rotation of the hip

Local trauma

Strengthening of hip external rotators and hip abductors

Stretching of muscles around the hip

Avoid sudden increase in activity (including intensity, duration, or pace)

Avoid exercise on banked surfaces

Proper shoe wear

Avoid direct trauma (use protection when appropriate).

Weight loss (if appropriate)

Etiology of bursitis:

Etiology of tendinopathy:

Pain localized to the area of the lateral hip is the key historical finding. This pain may radiate down the lateral thigh or into the groin (8).

Pain is often aggravated by (8):

Patient also may report other related conditions as seen in “Risk Factors.”

Tenderness over the greater trochanter is the key diagnostic finding (6).

Other exam tests may be positive but are less specific and lack sensitivity (9):

Other testing to evaluate for associated conditions:

Lumbosacral disk disease

Spinal stenosis

Radiculopathy

Degenerative disease of the hip

Osteonecrosis of the hip

Stress fracture of the hip

Slipped capital femoral epiphysis

Fracture

Contusion

Soft tissue infection