eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Trochanteric Bursitis: Differential Diagnoses & Workup

Author: Patrick M Foye, MD, FAAPMR, FAAEM, 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
Coauthor(s): Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
Contributor Information and Disclosures

Updated: Oct 1, 2009

Differential Diagnoses

Osteoarthritis

Other Problems to Be Considered

Fracture of the femur: This must be considered if significant trauma has occurred, particularly in elderly or osteoporotic individuals.
Avascular necrosis of the femoral head
Hip fracture (eg, stress fracture of the femoral neck)
Lumbosacral radiculopathy and trochanteric bursitis: Both can cause pain that radiates down the lower limb.
Gluteus medius bursitis
Gluteus medius partial tear
Iliopsoas bursitis
ITB tendinitis
Osteoarthritis of the hip: Note, however, that this disorder generally manifests with groin or knee pain.
Soft-tissue metastases11
Tuberculous trochanteric bursitis12
Iliopsoas tendonitis13
"Internal" snapping hip13
"External" snapping hip13
Iliotibial band inflammation13
Gluteal tendon injury13

Workup

Laboratory Studies

  • Generally, no laboratory studies are necessary for the diagnosis of trochanteric bursitis.
  • On rare occasions, blood work may be needed to rule out infection or connective-tissue disease.

Imaging Studies

  • Plain radiographs of the hip and femur may be performed to assess for possible fracture, underlying degenerative arthritis, or bony lesions. Pelvic tilting caused by a leg length discrepancy may be appreciated better with standing anteroposterior pelvis and hip films.
  • Bone scanning, computed tomography (CT) scanning, and MRI also can be used to exclude underlying diseases. In patients who are suffering from greater trochanteric pain, MRI and ultrasonographic scans potentially can be employed to differentiate gluteus medius tendinitis from trochanteric bursitis.14
  • A 2008 study concluded that on MRI examination, patients with trochanteric bursitis have peritrochanteric T2-signal abnormalities and a higher incidence of abductor tendinopathy. However, the report cautioned that MRI is a poor predictor of trochanteric bursitis, because these findings are not specific to this pathology.15

Procedures

  • Occasionally, diagnostic injection of local anesthetic into the trochanteric bursa may be helpful, particularly in an obese individual in whom the diagnosis is not yet certain.

Histologic Findings

Bursal inflammation

More on Trochanteric Bursitis

Overview: Trochanteric Bursitis
Differential Diagnoses & Workup: Trochanteric Bursitis
Treatment & Medication: Trochanteric Bursitis
Follow-up: Trochanteric Bursitis
Multimedia: Trochanteric Bursitis
References
Further Reading
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References

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

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

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

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

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

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

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

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

  9. 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. Aug 2003;85(6):913-7. [Medline].

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

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

  12. 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].

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

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

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

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

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

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

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

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

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

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

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

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

  25. 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. Apr 14 2009;338:b1088. [Medline]. [Full Text].

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

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

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

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

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Further Reading

Related eMedicine topics:
Bursitis [Emergency Medicine]
Bursitis [Orthopedic Surgery]
Snapping Hip Syndrome
The Approach to the Painful Joint

Clinical trials:
Steroid Injection for the Treatment of Greater Trochanteric Pain Syndrome

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Keywords

trochanteric bursitis, bursitis, trochanter, bursitis hip, greater trochanteric bursitis, bursitis injection, trochanteric injection, greater trochanteric pain syndrome, extra-articular snapping hip syndrome, external snapping hip syndrome, painful inflammation of the bursa, lateral hip pain, repetitive contracture of gluteus medius, repetitive contracture of the iliotibial band

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Contributor Information and Disclosures

Author

Patrick M Foye, MD, FAAPMR, FAAEM, 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, FAAPMR, FAAEM 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.

Coauthor(s)

Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
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.

Medical Editor

Rajesh R Yadav, MD, Assistant Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, 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

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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