Trochanteric bursitis causes rather typical symptoms. The main symptom is pain, that is profoundly felt at the hip joint and spreads to the lateral side of the hip, although it does not affect the whole length of the leg. The pain worsens when one engages in physical activity of any type, including walking, running etc., or when one simply lies down on that side while sleeping.

Other typical findings include a considerable point tenderness at sites proximal to the trochanteric region [14]. Edema of the bursal region may also be present, but it is usually difficult to palpate. Movements carried out by the physician, such as an external hip rotation or flexion, induce further pain in patients suffering from trochanteric bursitis [15]. The types of movements that cause pain can be used diagnostically to differentiate between trochanteric bursitis and other pathologies leading to a similar clinical picture [16].

• Weakness

  A full pain-free range of motion of the right hip was associated with weakness in the hip abductors. The patient ambulated with a compensated right Trendelenburg gait. [ncbi.nlm.nih.gov]

  While gluteal muscle weakness does become more prevalent as we age, we certainly also see weakness in the younger active population. [physioworks.com.au]

  Having weak hip abductors will signify poor hip stability and biomechanics, placing more pressure on the bursa. [coreconcepts.com.sg]

  Tightness and weakness in these muscle groups may be a contributing factor in symptoms of both ITB friction syndrome and GTB. [uwhealth.org]

• Weight Loss

  Patients often state that they are unable to lose weight because pain limits their ability to exercise. Weight loss is a dietary issue and pain (of any sort) should never be used as an excuse for obesity. [kingsleyphysio.com]

  Home treatment for bursitis includes: Rest Ice packs to the affected area Anti-inflammatory medications to relieve pain and swelling Weight loss, to reduce pressure on the hip Exercises for the hip and lower back Avoiding activities that cause pain [summitortho.com]

  Weight loss, to reduce pressure on the hip. Exercises to strengthen the hip muscles. Stretching exercises for the hip and lower back. Avoiding prolonged standing and the activity that causes pain. [myhealth.alberta.ca]

• Surgical Procedure

  The harvesting of the bursa required no modification of the surgical procedure. The specimens were then examined by 2 independent pathologists who were blinded as to the patients' clinical status. [ncbi.nlm.nih.gov]

  Bursitis may sometimes result from an injury or fall to the hip or after a surgical procedure of the hip. Spine disease, rheumatoid arthritis and leg length inequality increases the risk for developing hip bursitis. [riversideorthopedics.com]

  Common treatment approaches include resting temporarily, taking pain relievers, and surgical procedures such as a bursectomy. [paindoctor.com]

  Surgery When pain is unbearable, your doctor may recommend undergoing a surgical procedure to correct any deformity to the hipbone. Surgery is usually an option when the bursae becomes thick and inflamed. [newhealthadvisor.com]

• Severe Pain

  Pain is often so severe that it disturbs your sleep. Soreness, swelling, limping and redness are some other common symptoms. [newhealthadvisor.com]

  Acute bursitis comes on suddenly; severe pain and limitation of motion of the affected joint are the principal signs. See also hygroma, intra-abdominal abscess. Chronic bursitis may follow the acute attacks. [medical-dictionary.thefreedictionary.com]

  A cortisone injection can be done for relief in cases of severe pain. Injury Prevention Trochanteric bursitis can be prevented by avoiding overuse and overtraining. [sportsmedtoday.com]

  For patients with more severe pain, a steroid injection with local anesthetic can frequently provide relief. Ice packs or sometime moist heat will provide symptomatic relief. [prpstopspain.com]

• Asymptomatic

  This final patient underwent a second, more extensive partial excision of the iliotibial band, and was asymptomatic 1 year later. [ncbi.nlm.nih.gov]

  Greater trochanter of the hip: attachment of the abductor mechanism and a complex of three bursae – MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers. [radsource.us]

• Flushing

  Plus, the enhanced blood flow helps in flushing cell waste and fluid build-up from the injury site - further enhancing the ability of the body to heal. [aidmybursa.com]

• Hip Pain

  This symptom complex, called greater trochanteric pain syndrome (GTPS), 1 can mimic other serious causes of hip pain, including avascular necrosis, stress fracture, and arthritis of the hip. [radsource.us]

  Trochanteric bursitis is an underdiagnosed, easily remediable cause of pain in RA. Specific examination for in presence should be a routine in all patients with RA, especially those with hip pain. [ncbi.nlm.nih.gov]

  These may include: Hip pain – direct pain on the hip that radiates up to thigh and buttocks If you feel tenderness and pain when giving more weight on the affected area Stiffness of hip especially when you press it. [allhealthsite.com]

  Low Back Pain and dysfunction can have a big impact and even cause lateral hip pain so make sure you address this also. For more reading on lateral hip pain – This is a good resource. Check out this quick hip stability and balance test! [physioprescription.com]

• Back Pain

  Six patients with low back pain had both hip and knee arthritis (including two patients with rheumatoid arthritis). Three patients had degenerative hip disease without low back complaints. [ncbi.nlm.nih.gov]

  The majority of patients in a trial were pain-free after receiving a new image-guided pulsed radiofrequency treatment for lower back pain and sciatica for just 10 minutes. Lower back pain is a... [painspa.co.uk]

  Predisposing factors include: abnormal hip biomechanics due to abnormal force vectors acting across the hip, age, gender, ipsilateral iliotibial band (ITB) pain, knee osteoarthritis, obesity, low back pain and specific sporting activities (3) Reference [gpnotebook.co.uk]

  pain, thyroid disease, disc disease of the lower back, gout and more. [londonorthopaedic.com]

• Buttock Pain

  Trochanteric bursitis typically causes the following symptoms: Pain on the outside of the hip and thigh or in the buttock. Pain when lying on the affected side. Pain when you press in or on the outside of the hip. [my.clevelandclinic.org]

  Symptoms Symptoms of trochanteric bursitis may include: Hip and sometimes buttock pain that spreads down the outside of the thigh and reaches the knee area; pain may be worse during activities such as walking, running, or sitting cross-legged with the [physiotherapieuniverselle.com]

  Symptoms of trochanteric bursitis may include: Hip pain, and sometimes buttock pain that spreads down the outside of the thigh to the knee area. [myhealth.alberta.ca]

• Low Back Pain

  Six patients with low back pain had both hip and knee arthritis (including two patients with rheumatoid arthritis). Three patients had degenerative hip disease without low back complaints. [ncbi.nlm.nih.gov]

  Predisposing factors include: abnormal hip biomechanics due to abnormal force vectors acting across the hip, age, gender, ipsilateral iliotibial band (ITB) pain, knee osteoarthritis, obesity, low back pain and specific sporting activities (3) Reference [gpnotebook.co.uk]

  Thus people with this condition may be labeled malingerers, or may undergo many ineffective treatments due to misdiagnosis. [2] It may also coexist with low back pain, arthritis, and obesity. [3] Signs and symptoms [ edit ] The primary symptom is hip [en.wikipedia.org]

  Other conditions associated with trochanteric bursitis include: chronic mechanical low back pain, degenerative arthritis or disc disease of the lower lumbar spine, degenerative joint disease of the knees, fibromyalgia, iliotibial band syndrome, inflammatory [cyberpt.com]

• Thigh Pain

  A 66-yr-old white woman presented with progressive complaints of right lateral hip and thigh pain associated with a disabling limp without an antecedent history of trauma. [ncbi.nlm.nih.gov]

  Typically the history is one of trauma to the hip or a gradual onset of hip pain. As the pain worsens, it can radiate done the side of the thigh or into the buttocks region, causing leg pain (sciatica). [prpstopspain.com]

  The tenderness may extend into the lower buttock and lateral thigh. Pain can also be reproduced by resisted abduction and external rotation. [gponline.com]

  Common symptoms include: Pain at the side of the hip, which may also be felt on the outside of the thigh Pain that is sharp or intense at first, but may become more of an ache Difficulty walking Joint stiffness Swelling and warmth of the hip joint Catching [medlineplus.gov]

• Irritability

  This thickening, constant irritation, and inflammation may result in the condition becoming chronic, or long lasting. Symptoms The first symptom of trochanteric bursitis is usually pain. [goldmanpt.com]

  Most people with pain on the side of the hip simply have irritation of the trochanteric bursa and iliotibial band, but in severe cases, tendonitis or a tear of the gluteus medius may also be present. [health.ucsd.edu]

  Overtime this causes irritation and inflammation at the bursa and thus pain. Similarly poor movement patterns can affect the way the hip joint or lower back moves which can further irritate the bursa. [moveforward.physio]

  The heavier the bag, the greater the irritation. The greater the irritation, the greater the chance of trochanteric bursitis. [dynamicchiropractic.com]

Trochanteric bursitis is diagnosed clinically and following the exclusion of other conditions that lead to a similar set of symptoms. The patient is expected to report symptoms such as pain radiating laterally down to the thigh, which worsens with physical strain. Laboratory testing serves as a method to exclude other potential pathologies, such as infection or autoimmune diseases, and imaging modalities, such as magnetic resonance imaging and computerized tomography scans, radiographs and ultrasonographic scans also serve as ways to exclude other conditions. A neurological assessment of the region is mandatory when the patient presents with such symptomatology and, should traumatization precede the onset of symptoms, the patient needs to be thoroughly evaluated for fractures before the diagnosis of trochanteric bursitis can be decided [17].

Greater trochanteric pain syndrome is mainly treated symptomatically. The application of cold compresses on the hip joint, avoiding physical exercise or excessive mobility, injected corticosteroids and the administration of painkillers, such as NSAIDs (non-steroidal anti-inflammatory drugs) are the most popular treatment options [18] [19]. Patients whose condition fails to ameliorate, despite appropriate therapeutic measures, may need to consult an orthopedic surgeon [20]. Special consideration should be taken with reference to age groups that may have some limitation regarding drug ingestion: the use of NSAIDs should not be liberal by the senior population and women who are expecting should avoid corticosteroid injections as the pregnancy progresses.

Posture and gait defects should also be addressed, as they contribute to the pathogenesis of greater trochanteric pain syndrome. Orthotics, braces, canes and various other devices can be prescribed, in order to correct the way a patient walks. In case the aforementioned measures do not achieve a satisfactory degree of improvement, other options, including transcutaneous electrical nerve stimulation or extracorporeal shock wave therapy, can be chosen.

Corticosteroid injections are also widely prescribed for the treatment of trochanteric bursitis. It has been observed that they exhibit considerable success in terms of pain management and in the duration of the results. The only contraindication for injected corticosteroids is advanced pregnancy and a hip that seems infected. Physical therapy, on the other hand, is an option to rehabilitate such patients: targeted exercises may help some patients recover faster. At the same time, maintaining low levels of strenuous activity is vital to avoid excessive pressure to the joint. As a last resort, surgery can correct the syndrome if conservative symptomatic treatment fails to do so [21].

The condition does not lead to death, but may cause considerable morbidity to affected individuals. Painful symptoms are usually experienced periodically and a certain degree of limping may be anticipated in some cases as well [13]. Treatment options, such as corticosteroid injections and physical therapy usually suffice to treat the symptoms.

There are many factors that contribute to the onset of trochanteric bursitis. An individual that has sustained trauma to the hip joint and particularly those whose daily physical activity leads to multiple falls (eg. athletes) or other types of trauma to this region, are susceptible to developing bursitis. Underlying conditions that affect the skeletal system, such as spinal deformities, or other conditions leading to an abnormally balanced gait can also contribute to the pathogenesis of the disease. Lastly, trochanteric bursitis can arise as a result of the piriformis syndrome, characterized by the insertion of the piriformis muscle into the trochanteric bursa or following arthroscopic surgery, although the latter occurs rarely [5] [6] [7]. Some patients may experience symptoms related to trochanteric bursitis without any of the aforementioned factors.

Trochanteric bursitis usually affects individuals older than 50 years old and exhibits a predilection for female patients. The discrepancy between women and men is greater when the bursitis affects both hips [8], and, in general, it has been estimated that women are affected by the condition as much as 4 times more frequently than men.

The basic pathophysiological alteration featured in cases of trochanteric bursitis include inflamed bursae. This inflammatory process is mostly induced by excessive physical exercise that leads to repeated falls with the side of the hip; other causes include a difference in the length of the patient's legs and surgical procedures performed on the hip [9]. During the past years, given the fact that other regional structures such as tendons or muscles are affected in cases of trochanteric bursitis, the condition is widely referred to as greater trochanteric pain syndrome [10] [11] [12]. Another reason for this classification change is that, apart from trochanteric bursae, there is a plethora of other regional bursae that may undergo an inflammatory process as well.

The key to preventing the occurrence of greater trochanteric pain syndrome is maintaining a healthy lifestyle, protecting oneself from repeated falls that damage the hip and engaging in physical exercise in such a way, so as to minimize damage dealt to the joint. Proper shoes that do not exert abnormal pressure to the legs are of paramount importance, as are special shoes designed for flat feet.

Trochanteric bursitis is otherwise known as greater trochanteric pain syndrome. It is a condition causing inflammation of the bursae which are adjacent to the greater femoral trochanter [1] [2] [3]. Pain at the hip joint that extends to the sides of the thigh is the predominant symptom [4].

Trochanteric bursitis is diagnosed clinically and with the aid of imaging modalities capable of evaluating the condition of the bursae, such as an ultrasonographic scan or a magnetic resonance imaging scan (MRI). Laboratory testing, X-ray scans and computerized tomography scans are mainly carried out in order to eliminate the possibility of other diseases, which can lead to similar symptomatology. The condition is treated symptomatically, with the administration of painkillers, physical therapy, corticosteroids and local anesthetics. Patients are advised to engage in physical exercise that does not burden the hip in an excessive manner, and a plethora of therapeutic options are available for those who do not respond to conservative treatment.

The hip joint is protected by the bursa, a sac filled with fluid that serves the purpose of a "shock-absorber", in order to minimize damage and friction between structures like the muscle, bone or tendon. The hip joint is one of the biggest joints of the body and withstands a great deal of pressure and weight on a daily basis. Under various circumstances, the protective bursa is damaged, becomes swollen or infected and leads to a condition referred to as the greater trochanteric pain syndrome, or trochanteric bursitis.

There are various causes that can lead to this condition. Amongst the popular ones are: repeated trauma to the hip due to a fall or blow to the area, excessive physical exercise that damages the hip, a difference in the length of one's legs and spinal deformities (eg. scoliosis). An infection can also cause this condition, as can many other systematic diseases, such as diabetes, gout or thyroid conditions. Trochanteric bursitis typically causes pain on one or both hips that reaches all the way down to the knee, while usually sparing the foot, swelling and a tingling sensation when one moves. Patients face a great deal of difficulty when walking or resuming motion after having remained in a sitting or lying position for a long time.

The condition is diagnosed with the aid of the medical history and symptoms, physical examination and tests that are mainly performed to rule out other causes, rather than to confirm trochanteric bursitis.

The first steps towards the reduction of pain and related symptomatology is applying some basic personal measures. Patients are advised to sleep with their weight on the hip that is unaffected, rest a lot and avoid intense physical activity that involves the legs and can burden the hip. Applying ice on the hip can help to reduce the swelling, and painkillers should also be encouraged if the pain is intolerable. Remaining in a standing or sitting position for a long time can adversely affect the hip joint; it should therefore be avoided. Footwear should be appropriate for the type of exercise undertaken, comfortable and orthotics should be prescribed for people with feet problems, since the feet influence the posture as well.

As far as further medications are concerned, corticosteroid injections have been proven efficient in reducing symptoms and achieving long-term results. There are other therapy options available for cases that do not respond to the types of treatment mentioned above, and surgery is chosen as the last option if nothing else proves beneficial.

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