Inflammation of the trochanteric bursa is one of the most common causes of hip pain . (See "Evaluation of the adult with hip pain".) Inflammation occurs in the lubricating sac located between the midpoint of the trochanteric process of the femur and the gluteus medius tendon/iliotibial tract (figure 1). A deeper bursal sac, located between the top of the superior trochanteric process and the gluteus medius tendon, can also become inflamed; this is referred to as deep trochanteric bursitis or gluteus medius bursitis. The symptoms, presentation, and treatment of bursitis in either location are virtually identical and, for the purposes of this review, will be referred to simply as trochanteric bursitis unless otherwise noted.
Trochanteric bursitis is caused by an exaggerated movement of the gluteus medius tendon and the tensor fascia over the outer femur. Repetitive flexing of the hip and direct pressure aggravate the condition. Untreated, the normally paper-thin bursal wall thickens, fibroses, and gradually loses its ability to lubricate the outer hip.
A disturbance in gait causes the vast majority of cases of trochanteric bursitis; even subtle gait impairment can increase friction and pressure over the trochanteric process. Common gait abnormalities that may result in trochanteric bursitis include lumbosacral spine disease (75 percent), leg length discrepancy (10 percent) , sacroiliac joint disorders (5 percent), knee arthritis, and ankle sprain.
Patients typically complain of lateral hip pain over the outer thigh or of difficulty with walking. The hip pain is usually aggravated by direct pressure; depending upon the degree of inflammation and swelling, pressure sensitivity ranges from mild morning pain and stiffness to intolerance to sleeping on the affected side. Patients may rub the thigh when describing the pain.
The diagnosis of uncomplicated trochanteric bursitis is based upon the following clinical findings: