Trochanteric Bursitis

• Types of bursitis causes

  • Friction from repetitive movements
  • Trauma
  • Inflammatory conditions (e.g., rheumatoid arthritis)
  • Infection – referred to as septic bursitis
• The typical presentation of trochanteric bursitis is a middle-aged patient with gradual-onset lateral hip pain (over the greater trochanter) that may radiate down the outer thigh
• The pain in trochanteric bursitis is described as aching or burning, 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 of trochanteric bursitis, there is tenderness over the greater trochanter and usually no swelling (unlikely bursitis in other areas)
• Special tests to establish the diagnosis of trochanteric bursitis

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

  Ask 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 test is when the other side of the pelvis drops down, suggesting weakness in the affected hip
• Resisted movements for trochanteric bursitis diagnosis

  Ask the patient to resist while you move their hip. For example, with the patient lying supine, abduct their leg at the hip while they try to resist the movement. Pain on resisted movement supports a diagnosis of bursitis
• Management options for trochanteric bursitis

  • 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