Physical Medicine and Rehabilitation for Trochanteric Bursitis 

  • Author: Patrick M Foye, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Jan 18, 2012
 

Background

Trochanteric bursitis is characterized by painful inflammation of the bursa located just superficial to the greater trochanter of the femur.[1, 2, 3] Patients typically complain of lateral hip pain, although the hip joint itself is not involved. The pain may radiate down the lateral aspect of the thigh.[4]

The term greater trochanteric pain syndrome (GTPS) is now being commonly substituted for trochanteric bursitis, because the inflammatory etiology of the pain is being refuted by current research, using ultrasonographic, magnetic resonance imaging (MRI) – based, and histologic evidence.[5]

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Pathophysiology

Inflammation of the affected bursa between the femoral trochanteric process and the gluteus medius/iliotibial tract may be caused by acute or repetitive (cumulative) trauma. Acute trauma includes contusions from falls, contact sports, and other sources of impact. Repetitive trauma includes bursal irritation resulting from friction by the iliotibial band (ITB), which is an extension of the tensor fascia lata muscle. (See image below.) Such repetitive, cumulative irritation often occurs in runners but can also be seen in less active individuals. Other predisposing factors include a leg-length discrepancy and lateral hip surgery.[6]

Iliotibial band at the lateral femoral condyle, wiIliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
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Epidemiology

Frequency

United States

Trochanteric bursitis is relatively common in physically active patients, as well as in sedentary individuals.

Unilateral and bilateral greater trochanteric pain syndrome (GTPS) have a prevalence of 15.0% and 8.5% in women, and of 6.6% and 1.9% men, respectively.[7]

International

In a study by Lievense and colleagues, the annual incidence of trochanteric pain in primary care was reported as being 1.8 patients per 1000.[8]

Mortality/Morbidity

  • No mortality is associated with trochanteric bursitis.
  • Morbidity includes chronic pain, limping, and pain-related sleep disturbances that occur when the patient is lying on the affected side.

Race

No racial predilection has been reported.

Sex

Lievense and colleagues found that trochanteric bursitis seems to be much more common in females (80%) than in males.[8]

Age

Trochanteric bursitis can occur in adults of any age. The condition can also develop as a complication (in an estimated 1.4% of cases) of arthroscopic surgery of the hip.[9, 10]

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Dev Sinha, MD  Resident Physician, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Health Systems

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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

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

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health 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.

Additional Contributors

Debra Ibrahim, 4th year medical student, New York College of Osteopathic Medicine, Class of 2008, assisted with the revision of this manuscript.

Evish Kamrava, 4th year medical student, St. George's University School of Medicine, Class of 2009, assisted with the 2008 revision of this manuscript.

Jason Lee, 4th year medical student, St. George's University School of Medicine, Class of 2010, assisted with the 2009 revision of this manuscript.

References

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  19. 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].

  20. 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].

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Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
This photo demonstrates one method of stretching the iliotibial band (ITB) in the standing position. One foot is crossed over the other, and the patient leans away from the side being stretched. The exercise is performed by letting the side to be stretched lean in toward the wall. The patient should feel the stretch at the lateral aspect of the hip that is closest to the wall. Stretching should be done in a controlled, sustained manner, never in a ballistic manner with sudden, jerking movements.
This photo demonstrates one method of stretching the iliotibial band (ITB) in the supine position. The foot that is ipsilateral to the stretch is crossed over the contralateral knee. Next, the thigh that is ipsilateral to the stretch is pulled across the midline (adduction). The patient should feel the stretch at the lateral aspect of the hip, in the area shown by the dark line. Stretching should be done in a controlled, sustained manner, never in a ballistic manner with sudden, jerking movements.
 
 
 
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