II. Definitions
- Trochanteric Bursitis
- Inflammation of bursa overlying hip greater trochanter
- Greater Trochanteric Pain Syndrome (GTPS)
- Not an inflammatory condition
- Degenerative Tendinopathy of gluteus medius and gluteus minimus tendons
- Bursal distention may occur secondarily
III. Epidemiology
- Most common cause of Lateral Hip Pain
- Greater Trochanteric Pain Syndrome (GTPS)
- Prevalence: 1.8 to 5.6 per 1000 adults/year
- Gender: More common in females by 4:1 ratio
- Peak ages 40-60 years old
IV. Causes
- Trochanteric Bursitis (less common than other causes)
- Gluteus Medius Tendinopathy
- Iliotibial band friction
- External Snapping Hip
V. Predisposing factors
- Chronic pressure or Trauma to bursa
- Friction from overlying IT Band common in runners
- More common in runners with poor Running biomechanics (increased hip adduction)
- Leg Length Discrepancy
- Obesity
- Rheumatoid Arthritis
- Knee Osteoarthritis
- Hip Osteoarthritis
- Hip ORIF with hardware causing irritation of bursa
- Lumbar Disc Disease or Low Back Pain
VI. Symptoms
- Typically not associated with known causative injury
- Pain overlying greater trochanter
- May radiate into lateral thigh down to level or into buttock (non-radicular)
- Night pain occurs if lying on affected side
- Palliative and provocative factors
- Worse when standing from seated or lying position
- Worse with legs crossed
- Worse with direct pressure on the affected side (e.g. lying on that side)
- Improves initially on walking
- Worse again after walking for >30 minutes
VII. Signs
- Point tenderness over lateral greater trochanter of hip
- Symptoms reproduced on hip adduction
- Adduction and internal rotation may also provoke
- FABER Test also provokes pain
- Trandelenburg gait
VIII. Radiology
- XRay lateral hip
- AP Pelvis
IX. Differential Diagnosis
- Hip Osteoarthritis
- Septic hip
- Snapping Hip
- Trochanteric Fracture
- Gluteus medius Tendonitis
- Tenderness above greater trochanter
-
Lumbar Disc Disease or Sciatica
- Affects foot, whereas Bursitis does not
- Bony lesion (e.g. metastasis)
X. Management
- NSAIDs
- Modify activity
- Trochanteric Bursa Injection
- Consider gluteus Medius tear (MRI or Ultrasound)
- Consult orthopedic hip surgery
- Extracorporal shock wave therapy
XI. Prognosis
- Resolves with conservative management in 90% of patients
XII. References
- Greene (2001) Musculoskeletal Care, AAOS, p. 335-6
- Cardone (2003) Am Fam Physician 67(10):2147-52 [PubMed]
- Kane (2019) Am Fam Physician 100(3): 147-57 [PubMed]