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Basics
The name trochanteric bursitis has been used in the historical literature to refer to pain at the lateral hip with tenderness over the greater trochanter. As more continues to be learned about potential sources of pain at the lateral hip and the discovery that many patients lack an inflammatory process, this condition has been referred to as greater trochanteric pain syndrome (GTPS) in the more recent literature (1).
Description
- Bursae are fluid-filled sacs found at bony protuberances, typically at tendon attachment sites:
- Multiple bursae are described in the area of the greater trochanter of the femur.
- These bursae correspond to 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 that surround the lateral hip include:
- ITB
- Tensor fasciae latae
- Gluteus maximus tendon
- Gluteus medius tendon
- Gluteus minimus tendon
- Quadratus femoris muscle
- Vastus lateralis tendon
- Piriformis tendon.
- Bursitis refers to inflammation of the bursa.
- Tendinopathy refers to any abnormality of a tendon, inflammatory or degenerative.
Epidemiology
Incidence
- In primary-care setting: 1.8 patients/1,000 persons/yr
- Predominant age: All ages:
- Peak incidence in 4th–6th decades
- Predominant sex: Female > Male
- Sports:
- Running
- Contact sports: Football, rugby, soccer
Risk Factors
Multiple factors have been implicated (1,2):
- Female
- Obesity
- Tight hip musculature or ITB
- Direct trauma
- Total hip arthroplasty
- Abnormal biomechanics or gait:
- Leg-length discrepancy
- Sacroiliac (SI) joint dysfunction
- Knee or hip osteoarthritis
- Abnormal foot mechanics (e.g., pes planus, overpronation)
- Neuromuscular disorder
Genetics
No known genetic factors
General Prevention
- Maintain ITB, hip, and lower-back flexibility and strength.
- Avoid direct trauma (use of appropriate padding in contact sports).
- Avoid banked running.
- Appropriate shoe wear
- Weight loss, if appropriate
Pathophysiology
- Acute: Abnormal gait or poor muscle flexibility and strength lead to:
- Friction on bursa, causing inflammatory response
- 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 (1)
Etiology
See “Risk Factors” and “Pathophysiology” sections.
Commonly Associated Conditions
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