Hip

Trochanteric Bursitis

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Trochanteric Bursitis, Greater Trochanteric Bursitis, Greater Trochanteric Pain Syndrome

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