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Trochanteric bursitis is a regional pain syndrome described as an aching and intermittent pain over the lateral hip region. It is one of the most common causes of hip pain with an incidence is 1.8 to 5.6 per 1000 adults in one year, mostly affecting the 40 to 60 year old age group. It is found in all age groups with a female to male ratio of 2 to 4:1. The area is under a great deal of strain while walking or climbing stairs as many bursa and tendons cross the area. The most common muscles that are affected are the gluteus maximus and piriformis muscles followed by the gluteus minimus and medius muscles. Any irritation of the bursa or tendinitis results in the development of an overload syndrome that can affect the surrounding tissues causing a diffuse difficult to localize pain.
The most common cause of hip bursitis pain is an alteration of the walking biomechanics in the lower extremity such as with hip or knee joint osteoarthritis. It also is associated with tendinous calcification, deconditioning with repetitive microtrauma, iliotibial band syndrome, and leg-length discrepancy. Also it can be caused by lumbar spondylosis or arthritis of the spine, obesity, pes planus or flat feet, residual weakness following spine or hip surgery, total hip arthroplasty, or trauma. With these changes, the tissues are overloaded resulting in microtrauma that eventually does not heal. Once enough tissue has broken down, pain develops and just gets worse even with limited activities.
The most common symptoms are acute, sub-acute or chronic intermittent sharp or aching pain on the lateral hip that can radiate into the lateral thigh. Maximal tenderness is often at the junction of the upper thigh and greater trochanter with maximal tenderness often located just posterior to the apex of the greater trochanter. The pain is most often worsened with active hip external rotation and abduction. It can be worsened with prolonged standing, prolonged walking, stairs and running. In time, calcifications can develop in the region of the greater trochanter which may lead to significant disability that can last months to years.
Other diseases that can mimic a hip bursitis include:
• Hip labral tear
• Avascular necrosis
• Femoral neck stress fracture
• Hip osteoarthritis• Lumbar compression fractures
• Lumbar spine degenerative changes
• Lumbar radiculopathy
The most important element of treating hip bursitis is behavior modification such as using a cane as well as weight loss to decrease the forces going into the lateral hip.
If there is a leg-length discrepancy, a heel lift may be helpful as well. Another critical element is pelvic girdle and lower back strengthening and stretching.
Ultrasound or fluoroscopic guidance can be very precise in accurately diagnosing the tendon or bursa that is causing the pain allowing for a definitive treatment
which may include a platelet-rich plasma injection. As the underlying etiology may last for many years causing severe disability, it is important to get expert evaluation and treatment.
Panagos A. Rehabilitation Medicine Quick Reference-Spine (ed. Buschbacher R.M.) New York: Demos Publishing; 2010. p. 202-203.
Shbeeb MI, Matteson EL. Trochanteric bursitis (greater trochanter pain syndrome). Mayo Clin Proc. 1996 Jun;71(6):565-9.