Physical Medicine and Rehabilitation for Trochanteric Bursitis
- Author: Patrick M Foye, MD; Chief Editor: Consuelo T Lorenzo, MD more...
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]
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, with the posterior fibers denoted. 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]
Brinker MR, Miller MD. The adult hip. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:269-85.
McGee DJ. Hip. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:333-71.
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.
Trochanteric bursitis. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:299-303.
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].
Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. In: Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:783-812.
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].
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].
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].
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].
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].
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].
Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. Dec 2008;24(12):1407-21. [Medline].
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].
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].
Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. Sep 2011;21(5):447-53. [Medline].
Slawski DP, Howard RF. Surgical management of refractory trochanteric bursitis. Am J Sports Med. Jan-Feb 1997;25(1):86-9. [Medline].
Baker CL Jr, Massie RV, Hurt WG, et al. Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy. Aug 2007;23(8):827-32. [Medline].
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].
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].
Fundamentals of procedural care. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:1-13.
Nonsteroidal anti-inflammatory drugs (NSAIDs). In: Green SM, ed. Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Pub; 2000:11-2.
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].
Olsen NK, Press JM, Young JL. Bursal injections. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:36-43.
Injection and corticosteroids. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:37-9.
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].
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. May-Jun 2011;9(3):226-34. [Medline]. [Full Text].
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].
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].
Hofmeister E, Engelhardt S. Necrotizing fasciitis as complication of injection into greater trochanteric bursa. Am J Orthop. May 2001;30(5):426-7. [Medline].
Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg. May 2009;108(5):1662-70. [Medline].

