Trochanteric Bursitis (Greater Trochanteric Pain Syndrome)

Descriptive text is not available for this image BASICS

Trochanteric bursitis is often used as a general term to describe lateral hip pain and tenderness over the greater trochanter. There may be inflammation at one of a number of bursa at the lateral hip, but more commonly, the pain is due to hip abductor tendon injury and external snapping hip. More recently, there has been a shift to describe this condition 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.
  • 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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