Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Trochanteric Bursitis Clinical Presentation

  • Author: Douglas D Dean, DO; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: May 16, 2016
 

History

The classic symptom is pain at the greater trochanteric region of the lateral hip. The pain may radiate down the lateral aspect of the ipsilateral thigh[4] ; however, it should not radiate all the way into the foot. Onset may be either insidious or acute. The symptoms are made worse when the patient lies on the affected bursa (that is, when lying in the lateral decubitus position). The pain may awaken the patient at night.

Hip movements (internal and external rotation), walking, running, weight bearing, and other strenuous activities can exacerbate the symptoms. Patients may report that the pain limits their strength and makes their legs feel weak.

Symptoms are often related to increased activity or exercise. With acute trauma, patients may recall specific details of the impact.

Next

Physical Examination

The most classic physical finding is point tenderness over the greater trochanter, which reproduces the presenting symptoms. Palpation may also reproduce pain that radiates down the lateral thigh. It has also been reported that tenderness to areas that are either superior or posterolateral to the trochanter can also be identified.[18] Bursal swelling may be present, but this may be difficult to appreciate in many patients. With recent trauma, overlying skin changes of ecchymosis with abrasions may be apparent.

In obese patients, it may be difficult to locate the trochanter directly. Consider using the iliac crest as a landmark and assessing for the trochanter approximately 8 inches (20 cm) below the pelvic brim. Also consider palpating the region while passively circumducting the hip.

Lateral hip pain can often be elicited by carrying out passive external rotation of the hip without provoking such symptoms by internal rotation or performing end-range adduction.[19] In addition, the external rotation can be combined with passive hip abduction. Lateral hip pain can be reproduced with flexion of the hip followed by resisted hip abduction. Groin pain or referred knee pain provoked by passive internal rotation of the hip may indicate hip joint pathology (eg, osteoarthritis). Performing other specific musculoskeletal examinations such as the Trendelenberg test and Ober test can help identify other structural derangements that may also lead to lateral hip pain.[19, 20]

To assess for sciatica or lumbosacral radiculopathy, perform a detailed neurologic examination of both lower extremities, including assessment of strength, reflexes, and sensation, as well as dural stretch maneuvers (eg, the straight leg raise).

Previous
Next

Complications

Complications of trochanteric bursitis may include the following:

  • Progressive or persistent pain
  • Reduced mobility
  • Limited activity level
  • Limping (antalgic gait)
  • Sleep disturbance, which is especially problematic for a patient who usually sleeps in the side-lying position

Potential complications resulting specifically from focal corticosteroid injection include the following:

  • Bleeding, bruising, infection, and allergic reactions occurring after the injection
  • Necrotizing fasciitis – This has been observed from a single steroid injection of the greater trochanteric bursa [21]
  • Transient elevation of blood glucose levels occurring after corticosteroid injection in a diabetic patient
  • Cardiac arrhythmia occurring after intravascular injection of a local anesthetic
  • Subcutaneous skin atrophy occurring with more superficial administration of corticosteroids
  • Peripheral nerve dysfunction if the injection is administered very close to or within a major nerve
Previous
 
 
Contributor Information and Disclosures
Author

Douglas D Dean, DO Resident Physician, Department of Physical Medicine and Rehabilitation, Eastern Virginia Medical School

Disclosure: Nothing to disclose.

Coauthor(s)

Peter Gonzalez, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, Eastern Virginia Medical School

Peter Gonzalez, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Milton J Klein, DO, MBA Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital and Ohio Valley General Hospital

Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Acknowledgements

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Patrick M Foye, MD Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding

Scott F Nadler, DO Assistant Director of Occupational/Musculoskeletal Medicine, Assistant Professor of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Director of Sports Medicine, University Hospital

Scott F Nadler, DO is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of Sports Medicine, American Medical Association, Association of Academic Physiatrists, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Todd P Stitik, MD Professor, Department of Physical Medicine and Rehabilitation, Director, Outpatient Occupational/Musculoskeletal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Rajesh R Yadav, MD Associate Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas Medical School at Houston

Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference would like to thank medical student Dena Abdelshahed and Drs. Greg Gazzillo, Debra Ibrahim, Evish Kamrava, Jason Lee, and Dev Sinha for their help in previous revisions of the source articles.

References
  1. Brinker MR, Miller MD. The adult hip. Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999. 269-85.

  2. Silva F, Adams T, Feinstein J, et al. Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol. 2008 Apr. 14(2):82-6. [Medline].

  3. Steinberg JG, Seybold EA. Hip and pelvis. Steinberg GG, Akins CM, Baran DT, eds. Orthopaedics in Primary Care. 3rd ed. Baltimore, Md: Lippincott, Williams & Wilkins; 1998. 171-203.

  4. Trochanteric bursitis. Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997. 299-303.

  5. Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996. 783-812.

  6. Viradia NK, Berger AA, Dahners LE. Relationship between width of greater trochanters and width of iliac wings in tronchanteric bursitis. Am J Orthop (Belle Mead NJ). 2011 Sep. 40(9):E159-62. [Medline].

  7. Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg. 2009 May. 108(5):1662-70. [Medline].

  8. McGee DJ. Hip. Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992. 333-71.

  9. Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. 2008 Dec. 24(12):1407-21. [Medline].

  10. Bianchi S, Martinoli C. Hip. Ultrasound of the Musculoskeletal System. Germany: Springer; 2007. 561-62.

  11. Clarke MT, Lee PT, Arora A, et al. Levels of metal ions after small- and large-diameter metal-on-metal hip arthroplasty. J Bone Joint Surg Br. 2003 Aug. 85(6):913-7. [Medline].

  12. Farmer KW, Jones LC, Brownson KE, et al. Trochanteric bursitis after total hip arthroplasty incidence and evaluation of response to treatment. J Arthroplasty. 2009 Mar 3. [Medline].

  13. Clarke MT, Arora A, Villar RN. Hip arthroscopy: complications in 1054 cases. Clin Orthop Relat Res. 2003 Jan. 84-8. [Medline].

  14. Fearon AM, Twin J, Dahlstrom JE, et al. Increased substance P expression in the trochanteric bursa of patients with greater trochanteric pain syndrome. Rheumatol Int. 2014 Oct. 34(10):1441-8. [Medline].

  15. Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. 2007 Aug. 88(8):988-92. [Medline].

  16. Lievense A, Bierma-Zeinstra S, Schouten B, et al. Prognosis of trochanteric pain in primary care. Br J Gen Pract. 2005 Mar. 55(512):199-204. [Medline]. [Full Text].

  17. Fearon AM, Cook JL, Scarvell JM, et al. Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. J Arthroplasty. 2014 Feb. 29(2):383-6. [Medline].

  18. Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001 Sep. 44(9):2138-45. [Medline].

  19. Ho GW, Howard TM. Greater trochanteric pain syndrome: more than bursitis and iliotibial tract friction. Curr Sports Med Rep. 2012 Sep-Oct. 11(5):232-8. [Medline].

  20. Kaltenborn A, Bourg CM, Gutzeit A, et al. The hip lag sign - prospective blinded trial of a new clinical sign to predict hip abductor damage. PLoS One. 2014. 9(3):e91560. [Medline]. [Full Text].

  21. Hofmeister E, Engelhardt S. Necrotizing fasciitis as complication of injection into greater trochanteric bursa. Am J Orthop. 2001 May. 30(5):426-7. [Medline].

  22. Bertoli AM, Saurit V, Alvarellos A, et al. Soft tissue metastases presenting as greater trochanteric pain syndrome. J Clin Rheumatol. 2003 Dec. 9(6):370-2. [Medline].

  23. Fearon AM, Scarvell JM, Cook JL, Smith PN. Does ultrasound correlate with surgical or histologic findings in greater trochanteric pain syndrome? A pilot study. Clin Orthop Relat Res. 2010 Jul. 468(7):1838-44. [Medline]. [Full Text].

  24. Kong A, Van der Vliet A, Zadow S. MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome. Eur Radiol. 2007 Jul. 17(7):1772-83. [Medline].

  25. Blankenbaker DG, Ullrick SR, Davis KW, et al. Correlation of MRI findings with clinical findings of trochanteric pain syndrome. Skeletal Radiol. 2008 Oct. 37(10):903-9. [Medline].

  26. McMahon SE, Smith TO, Hing CB. A Systematic Review of Imaging Modalities in the Diagnosis of Greater Trochanteric Pain Syndrome. Musculoskeletal Care. 2012 Jul 4. [Medline].

  27. Nonsteroidal anti-inflammatory drugs (NSAIDs). Green SM, ed. Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Pub; 2000. 11-2.

  28. Furia JP, Rompe JD, Maffulli N. Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. Am J Sports Med. 2009 Sep. 37(9):1806-13. [Medline].

  29. Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. 2011 Sep. 21(5):447-53. [Medline].

  30. Fundamentals of procedural care. Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995. 1-13.

  31. Slawski DP, Howard RF. Surgical management of refractory trochanteric bursitis. Am J Sports Med. 1997 Jan-Feb. 25(1):86-9. [Medline].

  32. Baker CL Jr, Massie RV, Hurt WG, et al. Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy. 2007 Aug. 23(8):827-32. [Medline].

  33. Farr D, Selesnick H, Janecki C, et al. Arthroscopic bursectomy with concomitant iliotibial band release for the treatment of recalcitrant trochanteric bursitis. Arthroscopy. 2007 Aug. 23(8):905.e1-5. [Medline].

  34. Voos JE, Rudzki JR, Shindle MK, et al. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy. 2007 Nov. 23(11):1246.e1-5. [Medline].

  35. Domínguez A, Seijas R, Ares O, et al. Clinical outcomes of trochanteric syndrome endoscopically treated. Arch Orthop Trauma Surg. 2015 Jan. 135(1):89-94. [Medline].

  36. Coulomb R, Essig J, Mares O, Asencio G, Kouyoumdjian P, May O. Clinical results of endoscopic treatment without repair for partial thickness gluteal tears. Orthop Traumatol Surg Res. 2016 May. 102 (3):391-5. [Medline].

  37. Olsen NK, Press JM, Young JL. Bursal injections. Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995. 36-43.

  38. Injection and corticosteroids. Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997. 37-9.

  39. Cohen SP, Strassels SA, Foster L, et al. Comparison of fluoroscopically guided and blind corticosteroid injections for greater trochanteric pain syndrome: multicentre randomised controlled trial. BMJ. 2009 Apr 14. 338:b1088. [Medline]. [Full Text].

  40. Brinks A, van Rijn RM, Willemsen SP, Bohnen AM, Verhaar JA, Koes BW, et al. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med. 2011 May-Jun. 9(3):226-34. [Medline]. [Full Text].

  41. Shbeeb MI, O'Duffy JD, Michet CJ, et al. Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol. 1996 Dec. 23(12):2104-6. [Medline].

  42. Cohen SP, Narvaez JC, Lebovits AH, et al. Corticosteroid injections for trochanteric bursitis: is fluoroscopy necessary? A pilot study. Br J Anaesth. 2005 Jan. 94(1):100-6. [Medline]. [Full Text].

  43. Vannet N, Ferran N, Thomas A, Ghandour A, O’Doherty A. The use of shockwave therapy in the treatment of trochanteric bursitis. J Bone Joint Surg Br Proceedings. 2010/07. 92-B:393. [Full Text].

  44. Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med. 2009 Oct. 37(10):1981-90. [Medline].

  45. Crespo M, Pigrau C, Flores X, et al. Tuberculous trochanteric bursitis: report of 5 cases and literature review. Scand J Infect Dis. 2004. 36(8):552-8. [Medline].

 
Previous
Next
 
Tr B = trochanteric bursa; G Med B = subgluteus medius bursa; G Min B = subgluteus minimus bursa.
Photo demonstrates method of stretching iliotibial band (ITB) in standing position. One foot is crossed over other, and patient leans away from side being stretched. Exercise is performed by allowing side that will be stretched to lean in toward wall. Patient should feel stretch at lateral aspect of hip that is closest to wall. Stretching should be done in controlled, sustained manner, never a ballistic manner with sudden jerking movements.
Photo demonstrates method of stretching iliotibial band (ITB) in supine position. Foot ipsilateral to stretch is crossed over contralateral knee. Next, thigh ipsilateral to stretch is pulled across midline (adduction). Patient should feel stretch at lateral aspect of hip, in area shown by dark line. Stretching should be done in controlled, sustained manner, never in ballistic manner with sudden jerking movements.
Table.
For trochanteric bursitis (greater trochanteric pain syndrome [GTPS]), medications are used primarily to decrease pain and inflammation. The most commonly used medications are oral nonsteroidal anti-inflammatory drugs (NSAIDs) and focal corticosteroid injections; these are employed in conjunction with the rest of the rehabilitation plan.
 
Although an off-label use, another option is symptomatic treatment with a topical, sustained-release local anesthetic patch, such as the Lidoderm (lidocaine transdermal) patch, especially when there is an associated sleep disturbance due to the patient lying on the side affected by GTPS.
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.