Trochanteric Bursitis

Ovid: 5-Minute Sports Medicine Consult, The

Trochanteric Bursitis
Verle Valentine
  • 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
Risk Factors
  • 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
No genetic predisposition is known.
General Prevention
  • 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:
    • Inflammation of the bursae can come from repetitive friction between the bony structures of the trochanter and the muscle, tendon, or fascial tissue that overlies the bursae.
    • Inflammation of the bursae also can come about owing to direct trauma to the lateral hip.
  • Etiology of tendinopathy:
    • Tendon changes can come about from acute or chronic overuse of a muscle tendon unit.
    • Weakness or tightness of the muscle tendon unit contributes to this condition.
Commonly Associated Conditions
See “Risk Factors.”
  • 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):
    • Prolonged walking
    • Rising after sitting
    • Lying on affected side
    • Squatting
    • Climbing
  • Patient also may report other related conditions as seen in “Risk Factors.”
Physical Exam
  • 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):
    • Pain with extremes of passive rotation, abduction, or adduction
    • Pain with resisted hip abduction and external or internal rotation
    • Positive Trendelenburg sign
  • Other testing to evaluate for associated conditions:
    • Positive Patrick-FABERE (flexion, abduction, external rotation, extension) testing for sacroiliac joint dysfunction or hip joint pathology
    • Ober test for iliotibial band flexibility
    • Flexion and extension of hip for hip joint pathology
    • Leg-length measurement for leg-length discrepancy
    • Foot inspection for pes planus or overpronation
    • Lower extremity neurologic assessment for lumbar radiculopathy or neuromuscular disorders
Diagnostic Tests & Interpretation
Blood tests are not altered by this condition.
  • Imaging is not essential for the diagnosis.
  • If radiography is done, it should include anteroposterior view and frog-leg lateral view of the affected hip.
  • Radiographs typically are normal but can show irregular bone formation or bony spurring at the greater trochanter owing to chronic bursitis or chronic tendinopathy.
  • Radiographs also may show associated degenerative disease of the hip joint or the lumbar spine.
Diagnostic Procedures/Surgery
  • Advanced imaging is rarely necessary.
  • Detection of abnormalities on MRI is a poor predictor of clinical syndrome (9).
  • Bone scan may show inflammatory component of this condition but is not needed as a diagnostic tool (7).
Differential Diagnosis
A wide variety of conditions should be considered (6,8):
  • 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


Ongoing Care
726.5 Enthesopathy of hip region

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