Trochanteric bursitis

Question 1

What is trochanteric bursitis?

Answer 1

refers to inflammation of a bursa over the greater trochanter on the outer hip

It produces pain localised at the outer hip, referred to as greater trochanteric pain syndrome.

Question 2

Presentation of trochanteric bursitis?

Answer 2

The typical presentation is a middle-aged patient with gradual-onset lateral hip pain (over the greater trochanter) that may radiate down the outer thigh. The pain is described as aching or burning. It is worse with activity, standing after sitting for a prolonged period and trying to sit cross-legged. It may disrupt sleep and be difficult to find a comfortable lying position.

On examination, there is tenderness over the greater trochanter. There is not usually any swelling (unlikely bursitis in other areas).

Question 3

special tests to establish the diagnosis:

Answer 3

Trendelenburg test
Resisted abduction of the hip
Resisted internal rotation of the hip
Resisted external rotation of the hip

The Trendelenburg test involves asking the patient to stand one-legged on the affected leg. Normally, the other side of the pelvis should remain level or tilt upwards slightly. A positive Trendelenburg test is when the other side of the pelvis drops down, suggesting weakness in the affected hip.

Question 4

Management of trochanteric bursitis?

Answer 4

Management options are:

Rest
Ice
Analgesia (e.g., ibuprofen or naproxen)
Physiotherapy
Steroid injections

Rarely, trochanteric bursitis can be caused by infection. This may present with warmth, erythema, swelling and pain over the bursa. The patient may have a fever. Treatment involves antibiotics.

It can take 6-9 months to recover fully, sometimes longer.