Trochanteric Bursitis: Symptoms, Types, Causes and Treatment

Trochanteric bursitis, often now called greater trochanteric pain syndrome (GTPS), is a common source of lateral hip pain that can significantly affect quality of life. While traditionally attributed to bursitis (inflammation of the bursa over the greater trochanter), recent studies reveal that many cases are due to tendinopathies or other soft tissue problems. Understanding trochanteric bursitis means exploring its symptoms, types, causes, and the most effective treatment approaches. This article synthesizes the latest evidence to provide a comprehensive overview for patients, clinicians, and anyone interested in musculoskeletal health.

Symptoms of Trochanteric Bursitis

Trochanteric bursitis typically presents with pain and tenderness over the lateral aspect of the hip. These symptoms can be subtle at first but may progress and interfere with daily activities. Recognizing the specific symptom pattern is key to distinguishing this condition from other causes of hip and leg pain.

Symptom	Features	Impact on Life	Source(s)
Lateral Hip Pain	Aching, sometimes sharp or burning	Difficulty walking, sleeping, exercising	1 2 4 6
Point Tenderness	Tender over greater trochanter	Discomfort with pressure or lying side	2 4 5 6
Radiation of Pain	Down lateral thigh, occasionally to knee	May mimic sciatica	2 4 5 9
Aggravating Activities	Worse with standing, stairs, lying on side	Reduces mobility, affects rest	6 9

Table 1: Key Symptoms

Lateral Hip Pain and Point Tenderness

The hallmark of trochanteric bursitis is persistent pain over the outer hip. The pain is usually localized to the area over the greater trochanter, the bony prominence at the side of the hip. Physical examination typically reveals point tenderness when this area is pressed 1 2 4 5.

• Patients often describe the pain as aching, though it may become sharp or burning with movement.
• The pain can radiate down the outer thigh, sometimes extending as far as the knee or even into the buttock 2 4 5 9.

Radiation of Pain

A unique feature is the potential for pain to radiate:

• Along the lateral thigh, following the path of the iliotibial band.
• Rarely, pain may extend below the knee or into the buttock, which can lead to confusion with sciatica or lumbar spine issues 2 4 6 9.

Aggravating and Relieving Factors

Certain activities and positions worsen symptoms:

• Lying on the affected side, standing for extended periods, or descending stairs can intensify pain 6 9.
• Crossing legs or prolonged weightbearing also commonly exacerbate symptoms.
• Many patients notice the pain is worse at night, especially when lying on the involved hip, leading to sleep disturbances 1 4.

Impact on Function

• Pain often limits walking, exercise, and daily activities.
• Over time, patients may develop a limp or avoid physical activity, potentially leading to muscle weakness and reduced quality of life 1 4 9.

Types of Trochanteric Bursitis

Though often grouped under "trochanteric bursitis," lateral hip pain can arise from different underlying issues. Understanding the types is crucial for accurate diagnosis and effective treatment.

Type	Primary Pathology	Distinguishing Features	Source(s)
Classic Bursitis	Inflamed trochanteric bursa	Swelling, warmth at site (rare)	1 4 13
Gluteal Tendinopathy	Gluteus medius/minimus tendons	Weakness, pain with abduction	3 8 9
Iliotibial Band Syndrome	ITB friction/compression	Pain worsens with movement	2 5 8 9
Mixed/Combined Syndromes	Multiple soft tissue structures	Overlapping symptoms, chronic course	2 7 8

Table 2: Types of Trochanteric Bursitis and Lateral Hip Pain

Classic Trochanteric Bursitis

Traditionally, lateral hip pain was attributed to inflammation of the trochanteric bursa (a fluid-filled sac that cushions the hip bone) 1 4 13. In true bursitis, there may be:

• Swelling or warmth over the greater trochanter (though this is not always present).
• Isolated tenderness without significant muscle weakness.

However, imaging and surgical studies show that true bursitis is present in only a minority of patients with lateral hip pain 8 9.

Gluteal Tendinopathy

Recent evidence suggests that most cases involve tendinopathy or tears of the gluteus medius and minimus muscles, which attach near the greater trochanter 3 8 9.

• Patients may experience weakness in hip abduction.
• Pain may worsen with certain movements or resisted muscle testing.
• Imaging often reveals tendinosis or even partial tears of these tendons 8.

Iliotibial Band (ITB) Syndrome

The iliotibial band can also play a role, especially in active adults and athletes 2 5 8 9.

• Repetitive friction or compression of the ITB over the greater trochanter can cause pain or aggravate underlying bursitis/tendinopathy.
• Pain is often activity-related, especially with running, walking, or climbing stairs.

Mixed/Combined Syndromes

In many patients, more than one structure is involved 2 7 8:

• Gluteal tendinopathy, bursitis, and ITB pathology can coexist, leading to complex and persistent symptoms.
• Comprehensive assessment is needed to identify all contributing factors.

Causes of Trochanteric Bursitis

Understanding what leads to trochanteric bursitis or GTPS can help with both prevention and tailored treatment. Multiple factors—anatomical, biomechanical, and lifestyle-related—play a role.

Cause	Mechanism/Contributors	Notable Risk Factors	Source(s)
Overuse/Repetitive Injury	Microtrauma to soft tissues	Running, prolonged standing	2 4 9
Hip Abductor Weakness	Pelvic instability, impingement	Sedentary lifestyle, aging	9
ITB Compression	Increased pressure on tendons/bursa	Tight ITB, anatomical variation	9 8
Trauma	Direct blow to lateral hip	Falls, sports injuries	4 9
Systemic Conditions	Inflammation, altered mechanics	Obesity, low back pain, arthritis	2 6 13
Idiopathic	No clear cause		13

Table 3: Causes and Risk Factors

Overuse and Repetitive Microtrauma

• Repetitive movements or overuse, especially in runners or those involved in activities with frequent hip motion, can irritate the bursa or stress the gluteal tendons 2 4 9.
• Prolonged standing or walking can also be triggers, particularly in those unaccustomed to such activities.

Hip Abductor Weakness and Abnormal Biomechanics

• Weakness in the hip abductor muscles (gluteus medius/minimus) leads to poor pelvic stability.
• This can cause increased compressive forces over the greater trochanter, especially during walking or running 9.
• Lateral pelvic tilt and altered gait mechanics further contribute to development of symptoms.

Iliotibial Band Compression

• A tight or thickened iliotibial band can compress the underlying bursa and gluteal tendons, leading to pain and inflammation 9 8.
• This is common in athletes and those with biomechanical imbalances.

Trauma

• Direct trauma, such as a fall onto the outer hip, can injure the bursa or tendons and trigger an acute episode 4 9.
• Chronic trauma from repeated minor impacts (e.g., sleeping on one side) can also play a role.

Systemic and Associated Conditions

• Obesity, osteoarthritis, and chronic low back pain are associated with a higher risk of GTPS 2 6 13.
• Systemic inflammatory conditions (e.g., rheumatoid arthritis) can occasionally cause or worsen bursitis 13.
• Women, particularly those between ages 40-60, are more frequently affected 2 6 9.

Idiopathic Cases

• In some instances, no obvious cause is found—these are classified as idiopathic 13.

Treatment of Trochanteric Bursitis

Management of trochanteric bursitis has evolved with new understanding of its underlying causes. Most patients respond to conservative (non-surgical) measures, though persistent cases may require targeted interventions.

Treatment	Approach/Modality	Effectiveness/Notes	Source(s)
Physical Therapy	Stretching, strengthening	First-line; high success rates	1 2 3 5 12
NSAIDs/Analgesics	Oral anti-inflammatories	Symptom relief, minimal side effects	1 2 3 4 5
Corticosteroid Injection	Local injection to bursa/tendon	Rapid pain relief; may need repeat	1 2 3 4 10 13
Weight Loss/Modification	Reduce load on hip	Helpful in overweight patients	2 5 9
Shockwave Therapy	Low-energy SWT	Effective in refractory cases	10 12
Surgery	Bursectomy, tendon repair	For cases unresponsive to other Tx	3 7 10 11
Patient Education	Posture, behavior modification	Reduces recurrence, improves outcomes	4

Table 4: Treatment Modalities for Trochanteric Bursitis

Conservative Treatments

Physical Therapy and Exercise

• Physical therapy is the mainstay of treatment, focusing on stretching tight structures (like the ITB) and strengthening weak hip abductors 1 2 3 5 12.
• Exercise programs may include:
  • Hip abductor strengthening
  • Stretching the iliotibial band
  • Core stability work

NSAIDs and Analgesics

• Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen can provide symptomatic relief, particularly in the early stages or during flare-ups 1 2 3 4 5.

Corticosteroid Injections

• Local injection of corticosteroids into the bursa or around the gluteal tendons provides rapid pain relief for many patients 1 2 3 4 10 13.
• These injections are often both diagnostic and therapeutic; if pain resolves after injection, it confirms the diagnosis.
• Some patients may require repeat injections, but repeated use should be limited to reduce the risk of tendon weakening.

Weight Loss and Activity Modification

• In overweight patients, weight loss reduces stress on the hip 2 5 9.
• Modifying activities—avoiding lying on the affected side, using supportive footwear, and correcting poor posture—can reduce recurrence 4.

Advanced and Interventional Treatments

Shockwave Therapy

• Low-energy shockwave therapy (SWT) has been shown to be effective for persistent cases that do not respond to first-line conservative treatments 10 12.
• This non-invasive therapy can reduce pain and promote tissue healing.

Surgery

• Surgical options are reserved for those with refractory symptoms after exhausting conservative measures 3 7 10 11.
• Procedures may include bursectomy (removal of the bursa), release of the ITB, tendon repair, or osteotomy.
• Arthroscopic bursectomy has demonstrated good pain relief and improved function in selected patients 11.

Patient Education and Self-Management

• Education regarding posture, activity modification, and exercises is crucial to recovery and prevention of recurrence 4.
• Addressing underlying biomechanical or systemic contributors is often necessary for sustained improvement.

Conclusion

Trochanteric bursitis and greater trochanteric pain syndrome are common, often overlapping conditions that cause significant discomfort and functional limitation. The evolving understanding of their underlying causes has led to more effective and targeted treatment strategies.

Key Points:

• Lateral hip pain and point tenderness over the greater trochanter are hallmark symptoms.
• True bursitis is less common than previously thought; gluteal tendinopathy and ITB pathology are frequent culprits.
• Causes include overuse, biomechanical factors, trauma, and systemic conditions.
• Most cases respond well to conservative treatments such as physical therapy, NSAIDs, and corticosteroid injections.
• Advanced therapies and surgery are reserved for persistent or complex cases.
• Patient education and addressing modifiable risk factors are essential for long-term success.

Understanding the spectrum of trochanteric bursitis helps ensure accurate diagnosis, appropriate treatment, and a better quality of life for those affected.