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trochanteric bursitis

Also see bursitis. Etiology: - leg leg discrepancy is a risk factor Pathology: - inflammation of bursa overlying greater trochanter of femur Clinical manifestations: 1) patients generally complain of lateral hip or thigh pain over the greater trochanter [2] - referred pain to the knee may occur - lateral hip pain with FABER test 2) pain with extension &/or flexion of the thigh 3) pain may worsen when sitting on a hard chair 4) pain may worsen when rising from a sitting position [4] 5) pain may improve with walking 6) full range of motion at hip except painful resisted abduction [2] 7) symptoms exacerbated when the patient lies on the affected side (compression of the bursa) or sometimes opposite side (stretching of the iliotibial band) 8) tenderness to palpation over the posterior aspect of the greater trochanter 9) pain over the affected greater trochanter increased going up or down steps 10) does not affect range of motion [2] Differential diagnosis: 1) referred pain from back or knee 2) heterotopic bone formation in patients with a history of hip arthroplasty 3) gluteal tendonitis 4) coxa saltans Management: 1) identify & eliminate provocative activities - avoid lying on bursa while sleeping 2) check for leg length discrepancy - prescribe orthotics if appropriate [4] 3) NSAID or acetaminophen 1st line [2] 4) glucocorticoid/local anesthetic injection - 40 mg of methylprednisolone into the trochanteric bursa [8] - injection under ultrasound guidance may be useful [5] 5) stretching exercises

Related

iliotibial band syndrome trochanteric bursa

Useful

joint/bursa injection (knee injection, subacromial bursa injection)

General

greater trochanteric pain syndrome bursitis repetitive strain disorder; repetitive motion disorder; cumulative trauma disorder; overuse syndrome

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 673-74
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Clyman B, in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  4. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  5. McEvoy JR et al. Ultrasound-guided corticosteroid injections for treatment of greater trochanteric pain syndrome: Greater trochanter bursa versus subgluteus medius bursa. AJR Am J Roentgenol 2013 Aug; 201:W313 PMID: 23883246 - Williams BS and Cohen SP Greater Trochanteric Pain Syndrome: A Review of Anatomy, Diagnosis and Treatment. Anesthesia & Analgesia. May 2009, 108:1662
  6. Strauss EJ, Nho SJ, Kelly BT. Greater trochanteric pain syndrome. Sports Med Arthrosc. 2010 Jun;18(2):113-9 PMID: 20473130
  7. NEJM Knowledge+ Question of the Week. March 23, 2021 https://knowledgeplus.nejm.org/question-of-week/4511/ - Barratt PA et al. Conservative treatments for greater trochanteric pain syndrome: a systematic review. Br J Sports Med 2017 Jan; 51:97. PMID: 27834675 - Redmond JM et al. Greater trochanteric pain syndrome. J Am Acad Orthop Surg 2016 Apr; 24:231. PMID: 26990713
  8. NEJM Knowledge+ Complex Medical Care