What is trochanteric bursitis?
Trochanteric bursitis, more accurately referred to as greater trochanteric pain syndrome, is a common condition causing pain over the outer side of the hip. The condition involves irritation and inflammation of the bursa, a small fluid-filled sac that helps reduce friction between the tendons and the greater trochanter, which is the prominent bone on the outside of the hip. In many cases, there is also associated irritation or degeneration of the gluteal tendons that attach to this area. Trochanteric bursitis can affect people of all ages but is more common in middle-aged adults and may interfere with walking, sleeping, exercise, and daily activities.
Causes
Trochanteric bursitis is usually caused by repetitive irritation or overload of the structures on the outer side of the hip. Common contributing factors include overuse, prolonged walking or running, changes in activity levels, poor biomechanics, muscle weakness, or direct trauma to the hip. It is also more common in individuals with lower back problems, hip arthritis, leg length differences, or altered gait patterns. In some patients, prolonged pressure on the side of the hip, such as sleeping on the affected side, can worsen symptoms.
Symptoms
Symptoms of hip arthritis often develop gradually and may worsen over time.
The common symptom include:
- Pain : over the outer aspect of the hip that may radiate down the outside of the thigh. Increases when lying on the affected side, walking long distances, when climbing stairs, when standing up from a seated position, during exercise or physical activity.
- Tenderness: when pressing over the bony prominence on the outside of the hip.
- Onset: gradual onset of symptoms over time.
- Injury: sudden onset of symptoms after increased activity or injury.
- Weakness: due to hip discomfort in some cases.
- Limping: due to pain or discomfort.
Diagnosis
Your surgeon will take a thorough clinical history and physical examination. During assessment, the clinician will evaluate the location of pain, tenderness over the greater trochanter, hip movement, muscle strength, and walking pattern. Specific examination tests may reproduce symptoms by stressing the gluteal tendons or compressing the bursa. Because pain from the lower back or hip joint can mimic trochanteric bursitis, careful assessment is important to exclude other potential causes of lateral hip pain.
Imaging
Imaging is not always required but may be useful when symptoms are persistent, severe, or when the diagnosis is uncertain. X-rays are commonly performed to assess the hip joint and exclude arthritis or other bony abnormalities. Ultrasound can identify inflammation of the bursa and abnormalities of the gluteal tendons, while MRI scans provide more detailed assessment of tendon injury, bursitis, or other soft tissue conditions around the hip. Imaging also helps guide treatment planning in patients who fail to improve with conservative management.
Treatment
Conservative (non-operative)
Most patients with trochanteric bursitis improve with non-surgical treatment. Conservative management typically includes activity modification, physiotherapy, stretching and strengthening exercises, particularly targeting the hip abductor muscles, and anti-inflammatory medications. Ice application and avoiding prolonged pressure on the affected side can also help relieve symptoms. In some cases, corticosteroid injections into the bursa may provide significant pain relief and reduce inflammation. Addressing contributing factors such as gait abnormalities, lower back issues, or muscle weakness is important in preventing recurrence.
Surgical Treatment
Surgery is rarely required for trochanteric bursitis and is generally reserved for patients with persistent symptoms that do not respond to prolonged conservative treatment. Surgical options may include removal of the inflamed bursa, repair of associated gluteal tendon tears, or procedures to reduce friction over the greater trochanter. These procedures are often performed arthroscopically or through minimally invasive techniques.
Recovery
Following surgery, rehabilitation focuses on restoring hip strength, flexibility, and function while gradually returning patients to normal activities.