Updated: 11/30/2019

Trochanteric Bursitis

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Evidence
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Snapshot
  • A 22-year-old college woman presents to her physician with lateral right hip pain. The pain has worsened since she started training for a marathon a few weeks ago. She runs on the same road every morning.  On physical exam, there is localized tenderness over the greater trochanter. Pain is elicited with passive external rotation of the right lower extremity.
Introduction
  • Clinical definition
    • pain caused by inflammation of the trochanteric bursa
  • Epidemiology
    • demographics
      • female > male
    • location
      • bursa superficial to the greater trochanter of the femur
    • risk factors
      • running on banked surfaces
      • contact sports
      • previous hip surgery
      • falls
      • leg-length discrepancy
  • Pathogenesis
    • acute trauma or repetitive trauma causes inflammation of the trochanteric bursa
Presentation
  • Symptoms
    • lateral hip pain that may radiate down the thigh
      • worsens with activity and exercise
      • difficulty sleeping on the affected side
    • no groin pain
      • a true hip disease has referred pain to the groin
  • Physical exam
    • localized tenderness of greater trochanter
    • pain elicited by passive external rotation of the hip
Imaging
  • Radiography
    • indication
      • typically not necessary unless the clinical diagnosis is unclear or to rule out a fracture
    • findings
      • within normal limits
  • Magnetic resonance imaging
    • indication
      • typically not necessary unless the clinical diagnosis is unclear or to rule out other pathologies
    • findings
      • increased signal in bursa on T2 sequence
Studies
  • Making the diagnosis
    • most cases are clinically diagnosed
Differential
  • Sciatica
    • distinguishing factor
      • physical exam usually does not reveal focal tenderness at the trochanteric bursa
Treatment
  • Conservative
    • physical therapy
      • indication
        • for all patients
    • rest and ice
      • indication
        • for all patients
  • Medical
    • nonsteroidal anti-inflammatory drugs (NSAIDs)
      • indication
        • pain management
    • injected corticosteroids
      • indication
        • management of pain that is refractory to NSAIDs
Complications
  • Persistent pain (greater trochanteric pain syndrome)
 

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