Trochanteric bursitis or greater trochanter pain syndrome (GTPS) is a hip pain condition that can be persistent and troubling, restricting mobility and sporting activity.
What Is Bursitis?
A bursa is a small sac that lies between tendons, ligaments and bones, or between the skin and bones. They have synovial linings that secrete a lubricating fluid, limiting the friction between structures as they move across each other.
When too much stress is applied to a bursa it become inflamed. It secretes excess fluid and there may be tenderness, swelling, pain on movement, redness and limited ability to move the area.
The greater trochanter is the bony lump easily felt on the outside of the hip. It has a bursa between it and the skin. Medically, trochanteric bursitis may be more correctly referred to as greater trochanter pain syndrome or GTPS because the pain may actually be due to a large number of structures in the vicinity.
The Reasons For Trochanteric Bursitis
This hip bursitis is an overuse syndrome as the bursa is stressed repetitively by walking or running. It can also occur with more violent trauma such as a fall on the hip or a sporting tackle.
People may be more likely to get this syndrome if they have lower limb, spinal or sacroiliac problems already, such as piriformis syndrome.
Who Gets Trochanteric Bursitis?
It appears to be much more common in women with one review putting it at 80% compared to men. Overall it is quite common at around 15% in women and 8.5% in men. There seems to be no pattern with age or race.
Treatment of Trochanteric Bursitis
A large number of treatments have been tried. Physiotherapy is a worthwhile starting point before more aggressive treatments.
Acute trochanteric bursitis can be treated by regular icing of the area to reduce the inflammation and by limiting aggravating activities. Once the initial pain has settled the physio may give stretching exercises to all the major muscles around the hip joint.
A graded return to the activity responsible for the problem is then planned and the patient will be given a long-term programme to minimise the chances of recurrence.
A physiotherapist will also assess whether there are gait abnormalities and prescribe insoles, braces or walking aids. Ultrasound and TENS can also be useful.
Corticosteroid injections have been shown to be an effective treatment for trochanteric bursitis, although x-ray guidance is preferred to increase the accuracy of the drug delivery.
Extracorporeal shock wave therapy or ESWT has also been shown to be an effective treatment.
Surgery is rarely required but involves removal of the bursa and lengthening of the iliotibial tract to reduce the forces acting on the area.
- Greater trochanteric pain syndrome. NICE. http://cks.nice.org.uk/greater-trochanteric-pain-syndrome-trochanteric-bursitis#!topicsummary
- Strauss, E. J., Nho, S. J., & Kelly, B. T. (2010). Greater trochanteric pain syndrome. Sports medicine and arthroscopy review, 18(2), 113-119.