Trochanteric bursitis

Greater trochanteric pain syndrome (GTPS) is defined as localised lateral hip pain with focal point tenderness to palpation over the greater trochanter with the patient in the side-lying position (1,2).

GTPS has for many years been clinically diagnosed as trochanteric bursitis. However several features have been observed which lead to a conclusion that the diagnosis of trochanteric bursitis may be inappropriate (1).

• three of the four cardinal signs of inflammation: calor (heat), rubor (redness), and oedema are uncommon in GTPS and only pain is a feature
• advanced imaging and surgical findings in patients with localised lateral hip pain have reported the following disorders with no real bursal involvement
  • incomplete tearing or avulsion of the anterior aspect of the gluteus medius and gluteus minimus tendons
  • external coxa saltans (snapping hip)
  • enthesiopathy
• radiological findings for patients with GTPS report variable incidence, with bursitis incidence ranging from 4% to 46% and gluteal tendinopathy ranging from 18% to 50% (1,2,3)

For these reasons, clinical condition involving pain at or around the greater trochanter has been known by the vaguer term 'greater trochanteric pain syndrome' (GTP) (1).

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:

1. Reid D. The management of greater trochanteric pain syndrome: A systematic literature review. Journal of Orthopaedics. 2016;13(1):15-28.
2. Del Buono A et al. Management of the greater trochanteric pain syndrome: a systematic review. Br Med Bull. 2012;102:115-31.
3. Klauser AS et al. Greater trochanteric pain syndrome. Semin Musculoskelet Radiol. 2013;17(1):43-8.