Trochanteric Bursitis (Greater Trochanteric Pain Syndrome)
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).
- 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.
- 1.8/1,000 persons/year
- Peak incidence in 4th to 6th decades
- 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.
- 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)
No known genetic factors
Multiple factors have been implicated (1):
- Female gender
- 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
- 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
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