3 Interesting facts about hip/trochanteric bursitis

Hip bursitis or trochanteric bursitis is a tricky condition. It’s sometimes called “the great mimicker” because its symptoms are easily mistaken for other conditions like back pain or gluteal muscle injuries. But I’ve also found that quite a few patients I’ve seen have been misdiagnosed as having trochanteric bursitis when in fact the pain was caused by something else.

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In the video below, I give a very detailed explanation of what causes the bursae over your lateral hip to become inflamed and sore and how you can help it to recover. In this article I’ve highlighted some interesting facts that even clinicians sometimes don’t take into consideration.

1. You have about 9 different bursae in the area of your lateral hip (the outside of the hip) and any of them can be the cause of your pain.

A bursa is a sac filled with fluid and you find them in most areas where your muscles and tendons cross over or attach into bones. They are meant to help reduce friction between the bones and overlying soft tissue.

There are several layers of muscle that attach into the top of your thigh bone from several directions, so it makes sense that you’ll have more than 1 bursa there. Bursae have lots of nerve endings and when they become irritated or inflamed can cause a lot of pain.

Adapted from Williams, B. S. and S. P. Cohen (2009). "Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment." Anesthesia & Analgesia 108(5): 1662-1670.

A popular treatment for bursitis is a corticosteroid injection. If your injection did not work, it may be that the clinician missed the spot. I always try to refer my patients to someone that I know will do an ultrasound guided injection. This means that the person doing the injection uses ultrasound to look at where she/he places the needle and can aim it much more accurately.

2. It’s difficult to diagnose

You would think that diagnosing trochanteric bursitis should be easy. Surely it’s a case of just pressing on the outside of the hip where the bursae are and seeing if it hurts? Erm no - the research has shown that there are several other injuries that also cause pain with pressure over that area.

Even the two most sensitive tests (pain when standing on one leg for 30 sec; pain with resisted hip external rotation) can also produce pain when you have gluteus medius tendinopathy.

Some of the injuries that can feel very similar to hip bursitis include referred pain from the lower back, gluteal tendinopathy and gluteal tendon tears. An experienced clinician will be able to distinguish between these conditions by taking a thorough history and listening to how you describe your symptoms, what makes it worse or better and by getting you to perform some specific tests.

3. Trochanteric bursitis likes company

Not only can lateral hip bursitis be misdiagnosed but it can also be present in addition to another condition. In one study researchers found that 91.6% of the patients that they examined had other associated conditions.

One of the most common “combinations” that I see in clinic is patients with ongoing lower back pain who also present with bursitis. Another example is glute med tendinopathy. If you want all the symptoms to improve you shouldn’t just treat one and leave the other. I go into this in a lot more detail in the video.

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

Best wishes

Maryke

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate, Facebook, Twitter or Instagram.

References:

1. Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. (Links to Amazon)

2. Rothschild B. Elusive trochanteric bursitis relief. Clinical Rheumatology 2019:1-1.

3. Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesthesia & Analgesia 2009;108(5):1662-70.