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Trochanteric Bursitis (Greater Trochanteric Pain Syndrome)

Trochanteric Bursitis (Greater Trochanteric Pain Syndrome) is a topic covered in the 5-Minute Clinical Consult.

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Basics

Trochanteric bursitis is the historical term referring to lateral hip pain and tenderness over the greater trochanter. Because many patients lack an inflammatory process within the trochanteric bursa, this condition has been more recently referred to as greater trochanteric pain syndrome (GTPS) (1).

Description

  • Bursae are fluid-filled sacs found primarily at tendon attachment sites with bony protuberances:
    • Multiple bursae are in the area of the greater trochanter of the femur.
    • These bursae are associated with the tendons of the gluteus muscles, iliotibial band (ITB), and tensor fasciae latae.
    • The subgluteus maximus bursa is implicated most commonly in lateral hip pain (1).
  • Other structures of the lateral hip include the following:
    • ITB, tensor fasciae latae, gluteus maximus tendon, gluteus medius tendon, gluteus minimus tendon, quadratus femoris muscle, vastus lateralis tendon, piriformis tendon
  • Bursitis refers to bursal inflammation.
  • Tendinopathy refers to any abnormality of a tendon, inflammatory or degenerative. Enthesopathy refers to abnormalities of the zones of attachment of ligaments and tendons to bones.

Epidemiology

Incidence
  • 1.8/1,000 persons/year
  • Peak incidence in 4th to 6th decades

Prevalence
  • Predominant sex: female > male
  • More common in running and contact athletes
    • Football, rugby, soccer

Etiology and Pathophysiology

  • Acute: Abnormal gait or poor muscle flexibility and strength imbalances lead to bursal friction and secondary inflammation.
    • Tendon overuse and inflammation
    • Direct trauma from contact or frequently lying with body weight on hip can cause an inflammatory response (“hip pointer”) as well.
  • Chronic
    • Fibrosis and thickening of bursal sac due to chronic inflammatory process
    • Tendinopathy due to chronic overuse and degeneration: gluteus medius and minimus most commonly involved (1)

Genetics
No known genetic factors

Risk Factors

Multiple factors have been implicated (1):

  • Female gender
  • Obesity
  • Tight hip musculature (including ITB)
  • Direct trauma
  • Total hip arthroplasty
  • Abnormal gait or pelvic architecture
    • Leg length discrepancy
    • Sacroiliac (SI) joint dysfunction
    • Knee or hip osteoarthritis
    • Abnormal foot mechanics (e.g., pes planus, overpronation)
    • Neuromuscular disorder: Trendelenburg gait

General Prevention

  • Maintain ITB, hip, and lower back flexibility and strength.
  • Avoid direct trauma (use of appropriate padding in contact sports).
  • Avoid prolonged running on banked or crowned surfaces.
  • Wear appropriate shoes.
  • Appropriate bedding and sleeping surface
  • Maintain appropriate body weight loss.

Commonly Associated Conditions

  • Biomechanical factors (1)
    • Tight ITBs, leg length discrepancy, SI joint dysfunction, pes planus
    • Width of greater trochanters greater than width of iliac wings
  • Other associated pathology (1):
    • Low back pain
    • Knee and hip osteoarthritis
    • Obesity

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Citation

Stephens, Mark B., et al., editors. "Trochanteric Bursitis (Greater Trochanteric Pain Syndrome)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688028/all/Trochanteric_Bursitis__Greater_Trochanteric_Pain_Syndrome_.
Trochanteric Bursitis (Greater Trochanteric Pain Syndrome). In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688028/all/Trochanteric_Bursitis__Greater_Trochanteric_Pain_Syndrome_. Accessed March 24, 2019.
Trochanteric Bursitis (Greater Trochanteric Pain Syndrome). (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688028/all/Trochanteric_Bursitis__Greater_Trochanteric_Pain_Syndrome_
Trochanteric Bursitis (Greater Trochanteric Pain Syndrome) [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 March 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688028/all/Trochanteric_Bursitis__Greater_Trochanteric_Pain_Syndrome_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Trochanteric Bursitis (Greater Trochanteric Pain Syndrome) ID - 1688028 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688028/all/Trochanteric_Bursitis__Greater_Trochanteric_Pain_Syndrome_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -