Trochanteric Bursitis 

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

Background

Trochanteric bursitis is characterized by painful inflammation of the bursa that is located just superficial to the greater trochanter of the femur. Patients typically complain of lateral hip pain, although the hip joint itself is not involved, because pain may radiate down the lateral aspect of the thigh.

Pathophysiology

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

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 ultrasound, magnetic resonance imaging (MRI), and histologic evidence.[1, 2]

For excellent patient education resources, visit eMedicine's Arthritis Center. Also, see eMedicine's patient education article Bursitis.

This picture demonstrates a method of stretching tThis 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 tThis 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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Epidemiology

Frequency

United States

Trochanteric bursitis (greater trochanteric pain syndrome, GTPS) is relatively common among physically active and sedentary patients and can occur as a complication of arthroscopic surgery of the hip. The overall complication rate has been estimated to be 1.4%.[3]

The prevalence of unilateral trochanteric bursitis (greater trochanteric pain syndrome, GTPS) is 15.0% in women and 8.5% in men and that of bilateral GTPS is 6.6% in women and 1.9% in men.[4]

Race

No racial predilection has been reported.

Sex

A study published in a British journal reported that there appeared to be a female preponderance (80%) of trochanteric bursitis (greater trochanteric pain syndrome, GTPS) relative to males.[5]

Age

Trochanteric bursitis (greater trochanteric pain syndrome, GTPS) can occur in adults of any age.

International

Lievense et al reported the annual incidence of trochanteric pain in primary care settings was 1.8 patients per 1000.[5]

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Sport-Specific Biomechanics

Athletic activities that are potentially associated with trochanteric bursitis (greater trochanteric pain syndrome, GTPS) include those involving running or sports that are associated with the possibility of falls and/or physical contact. Other contributing factors may include running on banked surfaces, which essentially produces a functional leg-length discrepancy because the contact surface of the downhill foot is lower.

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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, 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

References

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

  3. Clarke MT, Arora A, Villar RN. Hip arthroscopy: complications in 1054 cases. Clin Orthop Relat Res. Jan 2003;406:84-8. [Medline].

  4. 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].

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

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  9. Fearon AM, Scarvell JM, Cook JL, Smith PN. Does ultrasound correlate with surgical or histologic findings in greater trochanteric pain syndrome? A pilot study. Clin Orthop Relat Res. Jul 2010;468(7):1838-44. [Medline]. [Full Text].

  10. 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].

  11. Vannet N, Ferran N, Thomas A, Ghandour A, O'Doherty A. The use of shockwave therapy in the treatment of of trochanteric bursitis. J Bone Joint Surg Br Proceedings. Jul 2010;92-B:393. [Full Text].

  12. Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med. Oct 2009;37(10):1981-90. [Medline].

  13. Shbeeb MI, O'Duffy JD, Michet CJ Jr, O'Fallon WM, Matteson EL. Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol. Dec 1996;23(12):2104-6. [Medline].

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

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

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

  17. Farmer KW, Jones LC, Brownson KE, Khanuja HS, Hungerford MW. Trochanteric bursitis after total hip arthroplasty: incidence and evaluation of response to treatment. J Arthroplasty. Feb 2010;25(2):208-12. [Medline].

  18. Green SM, ed. Nonsteroidal anti-inflammatories. Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Publishing; 2000:11-2.

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

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

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

  22. Pretell J, Ortega J, Garcia-Rayo R, Resines C. Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis. Int Orthop. Oct 2009;33(5):1223-7. [Medline].

  23. Snider RK. Hip and thigh. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy Orthopedic Surgeons; 1997:264-303.

  24. Snider RK. Injection and corticosteroids. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy Orthopedic Surgeons; 1997:37-9.

  25. 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; 1999:171-203.

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

 
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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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