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

Trochanteric Bursitis

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

Introduction

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 and Image 1.) 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, w...

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

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Iliotibial band at the lateral femoral condyle, w...

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


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

Clinical

History

  • With acute trauma, patients may recall specific details of the impact.
  • The classic symptom is pain at the greater trochanteric region of the lateral hip.
  • Pain may radiate down the lateral aspect of the ipsilateral thigh; however, it should not radiate all the way into the foot.
  • 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.
  • Onset may be insidious or acute.
  • Symptoms are often related to increased activity or exercise.

Physical

  • The most classic finding is point tenderness over the greater trochanter, which reproduces the presenting symptoms.
  • Palpation may also reproduce pain that radiates down the lateral thigh.
  • Bursal swelling may be present, but this may be difficult to appreciate in many patients.
  • 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.
  • Overlying skin changes of ecchymosis with abrasions may occur with recent trauma.
  • Lateral hip pain can often be elicited by passive external rotation of the hip without provoking such symptoms by internal rotation. Also, the external rotation can be combined with passive hip abduction.
  • Lateral hip pain can be reproduced with flexion of the hip and followed by resisted hip abduction.
  • Groin pain or referred knee pain provoked by passive internal rotation of the hip may indicate hip joint pathology (such as osteoarthritis).
  • To assess for sciatica or lumbosacral radiculopathy, perform a detailed neurologic examination of both lower extremities, including assessments of strength, reflexes, sensation, and dural stretch maneuvers (such as the straight leg raise).

Causes

  • Acute trauma, such as a fall or tackle, that causes the patient to land on the lateral hip region can result in trochanteric bursitis.
  • More commonly, repetitive (cumulative) trauma is involved. Such trauma is caused by the repetitive contracture of the gluteus medius and/or the ITB during running or walking.
  • Conditions that predispose patients to trochanteric bursitis include underlying lower leg gait and back or sacroiliac disturbances.
  • At times, the bursitis develops spontaneously without apparent precipitating factors.

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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