What Causes Trochanteric Bursitis?

The main symptom of trochanteric bursitis (greater trochanteric pain syndrome) is pain on the side of the hip.

Trochanteric bursitis, now called greater trochanteric pain syndrome, is a common cause of hip pain in adults. Patients often complain of pain on the outside of the hips (lateral hip pain), but the cartilage of the hip joint is not involved. 

The main symptom of trochanteric bursitis (greater trochanteric pain syndrome) is pain on the side of the hip. 

• Pain may radiate from the outside of the hip down the outside of the thigh
• Pain does not radiate all the way into the foot
• The onset of pain may be acute (sudden) or slow
• Symptoms worsen when laying on the affected side
• Hip movements from walking, running, weight-bearing, and other strenuous activities may worsen symptoms
• Pain may cause legs to feel weak and limit leg and hip strength

Causes of trochanteric bursitis (greater trochanteric pain syndrome) include:

• Overload of the tendons (tendinopathy) of the gluteus medius or minimus
• Acute trauma from a fall or tackle that causes the patient to land on the side of the hip
• Repetitive trauma, such as from running or walking
• Arthroscopic hip surgery 
• Certain pre-existing conditions
  • Lower leg gait disturbances
  • Spinal disorders
  • Sacroiliac disturbances
  • Piriformis syndrome
  • Osteoarthritis of the hip (though this often presents as groin or knee pain rather than lateral hip pain) 

Risk factors for developing trochanteric bursitis (greater trochanteric pain syndrome) include:

• Obesity
• Female gender
• Knee pain
• Low back pain
• Scoliosis
• Leg length discrepancy
• Joint problems/arthritis of the hip, knee, and foot
• Foot pain disorders such as plantar fasciitis, Achilles tendinopathy, bunions, Morton’s neuroma, or calluses

Trochanteric bursitis (trochanteric pain syndrome) is usually diagnosed with a physical exam. 

• The affected area may be palpated (felt) and there is tenderness over the outside of the hip (the greater trochanter). 
• When palpated, pain may also radiate down the outside of the thigh 
• Observation of how a patient walks, sits and rises to form a chair, and removes shoes and socks 
• Identifying other factors that may contribute to trochanteric bursitides (trochanteric pain syndrome) such as obesity, scolioses, lower back pain, leg length discrepancies, arthritis of the hip and lower extremities, and foot pain disorders such as plantar fasciitis, Achilles tendinopathy, bunions, Morton’s neuroma, or calluses
• Maneuvers to help diagnose the condition or rule out other conditions:
  • Standing on one leg for 30 seconds 
  • Resisted external derotation test 
  • Passive adduction with resisted abduction 
  • FABER (flexion-abduction-external rotation) test, or Patrick test
• Other tests and maneuvers:
  • Leg length measurement 
  • The Ober test 
• Imaging tests:
  • X-rays
  • Ultrasound
  • Magnetic resonance imaging (MRI)
  • Bone scans 
  • Computed tomography (CT) scans
• Platelet-rich plasma (PRP) injections are controversial and their effectiveness has not been established for trochanteric bursitis (trochanteric pain syndrome)

Treatment for trochanteric bursitis (trochanteric pain syndrome) includes:

• Rest/activity restriction 
  • Minimize climbing stairs, walking up hills
• Ice
• Injection of corticosteroids and local anesthetics
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Topical, local anesthetic patches
• Extracorporeal shock wave therapy (ESWT) 
• Transcutaneous electrical nerve stimulation (TENS)
• Physical therapy
  • Stretching the iliotibial band, tensor fascia lata, external hip rotators, quadriceps, and the hip flexors
  • Phonophoresis 
  • Soft-tissue massage 
• Surgery (rarely needed) 
  • Longitudinal release of the iliotibial band combined with subgluteal bursectomy 
  • Bursectomy and partial resection of the greater trochanteric process

Complications of trochanteric bursitis (trochanteric pain syndrome) include:

• Chronic pain
• Limping
• Sleep disturbances due to pain when a patient is lying on the affected side

To prevent pain from trochanteric bursitis (trochanteric pain syndrome):

• Avoid lying on the affected side
• Maintain a healthy weight
• For those who participate in sports:
  • Warm-up before exercise/sports
  • Train appropriately 
  • Avoid constant activities on banked surfaces, such as running on an embankment