Hip
Trochanteric Bursitis
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Trochanteric Bursitis
, Greater Trochanteric Bursitis, Greater Trochanteric Pain Syndrome
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
Epidemiology
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
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
Symptoms
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
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
Radiology
XRay lateral hip
AP
Pelvis
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)
Management
NSAID
s
Modify activity
Trochanteric Bursa Injection
Extracorporal shock wave therapy
Prognosis
Resolves with conservative management in 90% of patients
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]
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