Trochanteric bursitis is painful inflammation of the bursa located just superficial to the greater trochanter of the femur (Figure 1), causing lateral hip pain that is aggravated by direct pressure (Figure 2)
Greater trochanteric bursitis typically is an overuse condition often seen in individuals who participate in sports such as running and bicycling (Figure 3). It is usually associated with repetitive hip and knee flexion (bending) and extension (straightening). Pain and inflammation associated with trochanteric bursitis is located on the outside of the hip.
Symptoms include pain on the outside of the hip and thigh or in the buttock, pain when pressing on the outside of the hip, and pain with walking or climbing up stairs (Figure 4). This pain may radiate down to the knee.
What causes trochanteric bursitis?
Trochanteric bursitis can be caused by a direct injury to the hip such as falling or bumping against objects directly. It can also be caused by overuse (running, bicycling, standing, etc.) and increased activity. Some medical conditions including rheumatoid arthritis and gout may also cause hip bursitis.
Differential Diagnosis of Trochanteric Bursitis
Piriformis syndrome may be a differential diagnosis (Figure 5). This condition is caused by repetitive motion leading to pain in the buttocks, often causing tingling and numbness that runs down the leg. The sciatic nerve is pinched by the piriformis muscle, producing the sensations of pain, tingling and numbness.
Another differential diagnosis is a gluteus medius tear (Figure 6). A partial tear of the gluteus medius tendon at its insertion into the greater trochanter, which can mimic the pain of greater trochanteric bursitis.
Another contributor to trochanteric bursitis includes stress fractures of the hip and femoral neck, which are common injuries in athletes (Figure 7). This is common among runners and patients with osteoporosis.
Conservative treatment of trochanteric bursitis includes anti-inflammatory medication, physical therapy and corticosteroid injections (Figure 8). Surgery in the form of a bursectomy may be considered when conservative treatment fails. Surgery for trochanteric bursitis is the last resort.
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