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Trochanteric bursitis is a common cause of lateral hip pain characterized by inflammation of the bursa overlying the greater trochanter of the femur. This condition frequently affects middle-aged adults and is more prevalent in women than men.
Anatomy and Pathophysiology:
The greater trochanteric bursa is a fluid-filled sac that reduces friction between the greater trochanter and the overlying iliotibial band during movement. When this bursa becomes inflamed, it results in pain and tenderness over the lateral aspect of the hip. The condition may develop from acute trauma, repetitive microtrauma, or overuse injuries.
Clinical Presentation:
Patients typically present with lateral hip pain that worsens with prolonged walking, climbing stairs, or lying on the affected side. Pain often radiates down the lateral thigh and may be accompanied by local tenderness and swelling. Physical examination reveals point tenderness over the greater trochanter, with pain exacerbated by hip abduction against resistance.
Risk Factors:
Leg length discrepancy
Altered gait mechanics
Obesity
Repetitive activities
Sports involving running
Hip arthritis
Previous hip surgery
Diagnosis:
Diagnosis is primarily clinical, based on history and physical examination. Imaging studies such as MRI or ultrasound may be utilized to confirm the diagnosis or rule out other conditions. X-rays can help exclude underlying bone pathology.
Treatment Approach:
Conservative management is the mainstay of treatment and includes:
Activity modification and rest from aggravating activities
Physical therapy focusing on hip abductor strengthening
NSAIDs for pain and inflammation control
Ice therapy during acute phases
Corticosteroid injections for refractory cases
Physical therapy exercises typically include:
Hip abductor strengthening
Iliotibial band stretching
Core strengthening
Gait training
Balance exercises
Prognosis:
Most patients respond well to conservative treatment within 4-6 weeks. However, some cases may become chronic and require ongoing management. Surgery is rarely indicated but may be considered in recalcitrant cases that fail conservative treatment.
Prevention:
Preventive measures include:
Maintaining appropriate body weight
Regular stretching and strengthening exercises
Proper footwear
Avoiding repetitive impact activities during acute phases
Addressing biomechanical abnormalities
Return to Activity:
A gradual return to activities is recommended once pain subsides. Activity modification and proper warm-up are essential to prevent recurrence. Athletes should focus on proper training techniques and avoid sudden increases in training intensity.
Trochanteric bursitis, also known as greater trochanteric pain syndrome (GTPS), is a common cause of lateral hip pain in athletes and active individuals. This condition involves inflammation of the bursa surrounding the greater trochanter of the femur, often accompanied by tendinopathy of the gluteus medius and minimus muscles. From a sports medicine perspective, understanding the etiology, diagnosis, and management of trochanteric bursitis is crucial for optimal patient care and return to sport.
• The greater trochanter is a bony prominence on the lateral aspect of the proximal femur.
• Multiple bursae surround the greater trochanter, with the most significant being the subgluteus maximus bursa.
• The gluteus medius and minimus muscles insert onto the greater trochanter, playing a crucial role in hip abduction and pelvic stability.
• The iliotibial band (ITB) passes over the greater trochanter, potentially contributing to friction and irritation.
Trochanteric bursitis in athletes can result from various factors:
• Overuse: Repetitive activities involving hip abduction or rotation (e.g., running, cycling).
• Biomechanical abnormalities: Leg length discrepancy, pelvic tilt, or foot pronation.
• Trauma: Direct impact to the lateral hip or falls.
• Muscle imbalances: Weakness in hip abductors or core muscles.
• Training errors: Sudden increases in training intensity or volume. • Improper technique: Poor form during sports-specific movements.
Athletes with trochanteric bursitis typically present with:
• Lateral hip pain, often described as sharp or burning.
• Pain exacerbated by activities such as running, climbing stairs, or lying on the affected side.
• Tenderness over the greater trochanter on palpation.
• Pain with resisted hip abduction.
• Possible referred pain down the lateral thigh.
Accurate diagnosis is essential for effective management:
• Detailed history: Onset, duration, and aggravating/relieving factors.
• Physical examination:
– Palpation of the greater trochanter and surrounding structures.
– Range of motion assessment of the hip.
– Strength testing of hip abductors and external rotators.
– Special tests: FABER test, Ober’s test, resisted external derotation test.
• Imaging studies:
– X-rays: To rule out bony abnormalities or calcifications.
– Ultrasound: Useful for visualizing bursitis and tendinopathy.
– MRI: Gold standard for assessing soft tissue pathology and ruling out intra-articular hip disorders.
Consider other potential causes of lateral hip pain:
• Femoral neck stress fracture
• Osteoarthritis of the hip
• Lumbar radiculopathy
• Snapping hip syndrome
• Iliotibial band syndrome
• Piriformis syndrome
Treatment of trochanteric bursitis in athletes should follow a comprehensive, multimodal approach:
1. Acute phase:
• Rest and activity modification
• Ice therapy
• NSAIDs for pain and inflammation control
2. Physical therapy:
• Stretching exercises for hip flexors, ITB, and piriformis
• Strengthening of hip abductors, external rotators, and core muscles
• Manual therapy techniques
• Gait retraining and biomechanical correction
3. Modalities:
• Ultrasound therapy
• Extracorporeal shock wave therapy (ESWT)
• Dry needling
4. Corticosteroid injections:
• Can provide short-term pain relief
• Use judiciously, as repeated injections may weaken tendon structures
5. Platelet-rich plasma (PRP) injections:
• Emerging treatment option for recalcitrant cases
• May promote tissue healing and regeneration
6. Surgical intervention:
• Rarely indicated
• Consider in cases refractory to conservative management
• Options include bursectomy, ITB release, or gluteal tendon repair
A structured return-to-sport protocol is crucial for athletes:
1. Pain-free activities of daily living
2. Restoration of full hip range of motion
3. Adequate strength in hip abductors and external rotators (>90% of unaffected side)
4. Gradual reintroduction of sport-specific activities
5. Progressive increase in training intensity and volume
6. Functional testing to assess readiness for full return
Educate athletes on preventive measures:
• Proper warm-up and cool-down routines
• Gradual progression of training intensity and volume
• Regular stretching and strengthening exercises for hip and core muscles
• Appropriate footwear and orthotics if indicated
• Addressing biomechanical abnormalities through technique modification
• Cross-training to reduce repetitive stress on the hip
• Runners: Analyze running gait, consider shoe modifications, and address any training errors.
• Cyclists: Ensure proper bike fit, particularly saddle height and position.
• Field sport athletes: Focus on cutting and pivoting techniques to reduce lateral hip stress.
• Swimmers: Address stroke mechanics, particularly in breaststroke swimmers.
With appropriate management, most athletes with trochanteric bursitis can expect:
• Symptom improvement within 4-6 weeks of conservative treatment
• Full return to sport within 8-12 weeks
• Potential for recurrence, emphasizing the importance of ongoing preventive measures
©2025 Dr Frank McCormick All Rights Reserved.
©2025 Dr Frank McCormick All Rights Reserved.
