Introduction
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. (See also the eMedicine article Iliotibial Band Syndrome.)
For excellent patient education resources, visit eMedicine's Arthritis Center. Also, see eMedicine's patient education article Bursitis.
Frequency
United States
Trochanteric bursitis 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%.1
The prevalence of unilateral 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.2
Race: No racial predilection has been reported.
Sex: A study published in a British journal reported that trochanteric bursitis there appeared to be a female preponderance (80%) relative to males.3
Age: Trochanteric bursitis 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 1000.3
Sport-Specific Biomechanics
Athletic activities that are potentially associated with trochanteric bursitis 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.
Clinical
History
- In cases of acute trauma, patients may recall the specific details of the impact that caused the injury.
- The classic symptom 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.
Physical
- The most classic finding 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 ecchymosis, 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. (See also the eMedicine article 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). (See also the eMedicine article Lumbosacral Radiculopathy.)
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 (See eMedicine topic Osteoarthritis.)
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References
Clarke MT, Arora A, Villar RN. Hip arthroscopy: complications in 1054 cases. Clin Orthop Relat Res. Jan 2003;406:84-8. [Medline].
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].
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].
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].
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].
Hofmeister E, Engelhardt S. Necrotizing fasciitis as complication of injection into greater trochanteric bursa. Am J Orthop. May 2001;30(5):426-7. [Medline].
Brinker MR, Miller MD. The adult hip. Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders Co; 1999:269-85.
Green SM, ed. Nonsteroidal anti-inflammatories. Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Publishing; 2000:11-2.
Lennard TA. Fundamentals of procedural care. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:1-13.
McGee DJ. Hip. Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1992:333-71.
Olsen NK, Press JM, Young JL. Bursal injections. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:36-43.
Snider RK. Hip and thigh. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy Orthopedic Surgeons; 1997:264-303.
Snider RK. Injection and corticosteroids. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy Orthopedic Surgeons; 1997:37-9.
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.
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.
Further Reading
Keywords
external snapping hip syndrome, lateral snapping hip syndrome, extra-articular snapping hip syndrome, greater trochanteric bursitis, greater trochanteric pain syndrome, GTPS, hip pain, thigh pain
