Greater Trochanteric Bursitis

synonyms:

Greater Trochanteric Bursitis ICD-9

• 726.5 (Enthesopathy of the hip region)

Greater Trochanteric Bursitis Etiology / Epidemiology / Natural History

• Results from friction between the greater trochanter and the iliotibial band during hip flexion and extension causeing microtrauma and bursal inflammation.
• Chronic greater trochanteric bursitis can lead to a painful limp and sleep difficulty

Greater Trochanteric Bursitis Anatomy

• The trochanteric bursa lies between the iliotibial band and the greater trochanter.

Greater Trochanteric Bursitis Clinical Evaluation

• Pain and tenderness over the affected greater trochanter. Pain is often worse when first rising from a seated / recombent position.
• Increased pain with adduction and internal rotation.
• Generally unable to lie on affected side.
• Pain may radiate into the buttock or down the leg into knee or ankle.
• Clinic Note

Greater Trochanteric Bursitis Xray / Diagnositc Tests

• A/P pelvis, A/P and lateral of the affected hip. May demonstrate rounded or irregular calcific deposits around the greater trochanter.
• Consider MRI / bone scan if concerned for occult fracture or tumor.

Greater Trochanteric Bursitis Classification / Treatment

• Initial treatment: physical therapy, NSAIDs, ICE, corticosteriod injection, short term cane use.
• Chronic Recalcitrant: open or arthroscopic bursectomy.
• Arthroscopic bursectomy: proximal portal just posterior to the tip of the trochanter. Distal portal just posterior to the inferior aspect of the bursa. (Baker, CL)

Greater Trochanteric Bursitis Associated Injuries / Differential Diagnosis

• Lumber degenerative disc disease
• Lumbar spinal stenosis
• Hip arthritis
• Limb-legth discrepancy
• Painful hardware (after ORIF of hip fractures)
• Metastatic tumor
• Sciatica
• Septic arthritis
• Snapping hip (Coxa Saltans)

Greater Trochanteric Bursitis Complications

• Greater trochanteric bursitis injection risks: infection, allergic reaction to local anesthetic or steriod preparation, fat atrophy, skin depigmentation
• Chronic pain
• Limp
• Difficulty sleeping

Greater Trochanteric Bursitis Follow-up Care

• May consider repeat injection if initial injection fails or symptoms return. Avoid multiple steriod injections.

Greater Trochanteric Bursitis Review References

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