Subspecialty Clinics: RheumatologyTrochanteric Bursitis (Greater Trochanter Pain Syndrome)
Section snippets
Anatomic Structures
Approximately 14 to 21 bursae have been described in the hip region.1, 2, 3 Of the four bursae usually present around the greater trochanter, three are constant—two major and one minor. The minor bursa is the gluteus minimus bursa, which lies above and slightly anterior to the proximal superior surface of the greater trochanter. The subgluteus medius bursa is a major bursa, which lies beneath the gluteus medius muscle, situated posterior and superior to the proximal edge of the greater
Causes And Pathogenesis
Although trauma is a known cause of trochanteric bursitis,6 only 23 to 64% of patients 1,4,5 recall a specific traumatic event. Trochanteric bursitis is likely often associated with repetitive microtrauma caused by active use of the muscles inserting on the greater trochanter that results in degenerative changes of tendons, muscles, or fibrous tissues. Alteration in the biomechanics of the lower extremity in conjunction with change of hip muscle mechanics caused by osteoarthritis of the joints
Report Of Case
A 54-year-old woman sought medical attention because of a 6-month history of waxing and waning right lateral hip pain, which extended into the lateral aspect of the ipsilateral thigh but rarely into the knee region. She initially noted the pain after climbing stairs. The pain was most severe at night, when she attempted to lie on her right side. She had no history of antecedent trauma. The pain was partially alleviated by the use of nonsteroidal anti-inflammatory drugs. She had chronic low-back
Symptoms
Trochanteric bursitis is characterized by chronic, intermittent aching pain over the lateral aspect of the hip. Occasionally, the onset of pain is acute or subacute, and the quality of pain can be sharp and intense. The pain extends into the lateral aspect of the thigh in 25 to 40% of cases; 1,4 however, it rarely extends into the posterior aspect of the thigh or distal to the knee. In a minority of patients, pain initially may be perceived in the low-back area or around the knee, but the
Physical Examination
Localized tenderness over the greater trochanter can be essentially elicited in all symptomatic patients. The area of maximal tenderness is identified at the junction of the upper thigh and the greater trochanter. While the patient is lying down with the painful hip uppermost, the examiner should palpate the hip in a cephalic direction, beginning below the greater trochanteric eminence until the area of maximal tenderness is identified.15 Typically, this area will be at the site of the gluteus
Radiographic Findings
No specific radiographic findings are diagnostic of trochanteric bursitis. Radiographs of the hip, pelvis, and lower lumbar spine may show evidence of one or more of the commonly associated musculoskeletal conditions. Calcifications around the greater trochanter may be evident in 40% of patients with trochanteric bursitis.4 They vary in shape and size, from a few millimeters to 3 to 4 cm in diameter. They appear as linear or small, rounded masses that are separated or grouped together; density
Diagnosis
The diagnosis of trochanteric bursitis is clinical. A typical history can be confirmed on physical examination. Symptoms often rapidly resolve after appropriate glucocorticoid and analgesic injection. The differential diagnosis should include any condition that can cause hip pain or low-back pain. Radiographs, although not diagnostic, should be obtained if an underlying associated osseous pathologic condition or arthritis is a concern.
In 1985, Ege Rasmussen and Fano12 modified a set of clinical
Treatment
Many initially reported cases of trochanteric bursitis, especially those associated with calcifications, were treated surgically with excision of the bursal sac and the accompanying calcifications.7,8During the first half of this century, most patients were treated conservatively with one or more of the following modalities: bed rest; simple physical therapy measures including ice, heat, and diathermy; and local anesthesia.1,10,21 During the 1930s and 1940s, some investigators used radiation
Conclusion
Trochanteric bursitis is a common regional soft tissue problem that is probably underdiagnosed. Effective treatment is available. We believe that, when standard treatment and correction of possible underlying causes fail, patients should undergo further assessment to determine whether the hip pain is attributed to trochanteric bursitis.
Acknowledgment
We thank Gene G. Hunder, M.D., for reviewing the submitted manuscript.
References (26)
- et al.
Noninfectious trochanteric bursitis and peritendinitis
Surg Clin North Am
(1952 Aug) Rheumatic disease aspects of leg length inequality
Semin Arthritis Rheum
(1988)The bursae of the body [editorial]
Ann Rheum Dis
(1965)Trochanteric bursitis and tendinitis
Clin Orthop
(1961)Pseudo-radiculopathy in subacute trochanteric bursitis of the subgluteus maximus bursa
Arch Phys Med Rehabil
(1976)- et al.
Traumatic trochanteric bursitis
Kans Med
(1989) Peritrochanteric bursitis
J Bone Joint Surg
(1931)- et al.
Supratrochanteric calcification
J Bone Joint Surg
(1936) Peritendinitis calcarea: a common disease of middle life; its diagnosis, pathology and treatment
AJR Am J Roentgenol
(1938)
Acute trochanteric bursitis with calcification
Surgery
Trochanteric bursitis: diagnostic criteria and clinical significance
Arch Phys Med Rehabil
Trochanteric bursitis: treatment by corticosteroid injection
Scand J Rheumatol
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