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

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

• Predominant sex: female > male
• More common in running and contact athletes (e.g., 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