Trochanteric Bursitis Clinical Presentation

  • Author: Patrick M Foye, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Aug 31, 2010
 

History

  • In cases of acute trauma, patients may recall the specific details of the impact that caused the injury.
  • The classic symptom of trochanteric bursitis (greater trochanteric pain syndrome, GTPS) is pain at the greater trochanteric region at the lateral hip.
  • The pain may radiate down the lateral aspect of the ipsilateral thigh but usually does not radiate all the way into the foot.
  • Typically, symptoms worsen when the patient is lying on the affected bursa (eg, lying in the lateral decubitus position on the affected side).
  • Pain may awaken the patient at night.
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Physical

  • The most classic finding in trochanteric bursitis (greater trochanteric pain syndrome, GTPS) is the elicitation of 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 finding may be difficult to appreciate in many patients.
  • In obese patients, direct location of the trochanter may be difficult. Consider using the iliac crest as a landmark and assessing for the trochanter approximately 8 inches (20 cm) below the pelvic brim. Attempt to palpate the region while passively circumducting the affected hip.
  • If recent acute trauma has occurred, skin changes may include ecchymoses, abrasions, or both.
  • Lateral hip pain can often be elicited with passive external rotation of the affected hip, whereas such symptoms are not provoked by internal rotation. External rotation can also be combined with passive hip abduction.
  • Lateral hip pain can also be reproduced with either passive hip adduction or active hip abduction.
  • Groin pain produced through passive internal rotation of the hip may indicate hip joint pathology, such as osteoarthritis. To assess for sciatica or lumbosacral radiculopathy, perform a careful neurologic examination in the bilateral lower limbs, including assessment of strength, reflexes, sensation, and dural stretch maneuvers (eg, straight-leg raise).
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Causes

  • Acute trauma
    • A fall or tackle with the patient landing on the lateral hip region
  • Repetitive (cumulative) trauma
    • More common involvement than acute trauma
    • Caused when patients with tightness of the ITB run or even walk
  • Other diagnostic considerations
    • Osteoarthritis of the hip, although this diagnosis generally manifests as groin or knee pain rather than lateral hip pain
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Proceed to Differential Diagnoses
 
 
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, 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.

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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine 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.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, 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: Nothing to disclose.

Chief Editor

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

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