Hip
Greater Trochanteric Bursitis
대전자 점액낭염
Lateral hip pain from inflammation of the bursa overlying the greater trochanter — part of GTPS
- How common
- Common
- Typical age
- Ages 30–60
What is it?
Inflammation and degenerative changes of the trochanteric bursa and surrounding soft tissues (IT band, gluteus medius tendon)
Commonly affected: Greater trochanteric bursa, iliotibial band, gluteus medius tendon
How it develops
- Repetitive FrictionRepetitive friction between IT band and greater trochanter irritates the bursa
- Bursal InflammationThickening and inflammatory response of the trochanteric bursa
- Tendon DegenerationConcomitant degenerative changes in gluteus medius and minimus tendons
- Pain ChronificationProgression to chronic pain through neural sensitization and muscle imbalance
Symptoms
- Lateral Hip PainLocalized tenderness over greater trochanter, may radiate down lateral thigh
- Night PainPain when lying on the affected side — highly specific for diagnosis
- Activity-Related WorseningWorsening with stairs, prolonged walking, running
- No Groin PainAbsent groin pain differentiates from hip OA — key differentiator
How it is examined
- Greater Trochanter TendernessReproduction of pain with direct palpation over greater trochanter → most important finding
- FABER TestProduces lateral hip pain (not groin) unlike hip OA → differentiation point
- Ober TestAssesses IT band tightness. Failure of IT band to relax in lateral decubitus → tight IT band
- FADER-R TestFlexion, ADduction, External Rotation with Resistance — detects gluteus medius tendon damage
Imaging
Usually normal; may show osteophytes or calcification
- Usually normal
- Greater trochanter osteophytes
- Calcific tendinitis may coexist
Useful for confirming bursal effusion and gluteus medius tendon damage
- Peritrochanteric bursal effusion (T2 hyperintense)
- Gluteus medius/minimus tendon thickening or tear
- IT band syndrome coexistence
Non-surgical care
- Activity ModificationAvoid aggravating activities, IT band stretching, side-lying position modification
- Physical TherapyGluteus medius strengthening, IT band/TFL stretching, eccentric exercises
- Steroid InjectionUltrasound-guided intraborsal steroid injection — excellent short-term effect
- ESWTExtracorporeal shock wave therapy effective when tendinopathy is present
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed conservative treatment 6-12 months, complete gluteus medius tendon tear
Procedures that may be discussed
- IT band release
- Bursectomy
- Gluteus medius tendon repair
Outlook
Most improve with conservative treatment. 60-80% short-term pain reduction after steroid injection