Trochanteric bursitis, also called greater trochanteric pain syndrome, is inflammation of the bursa that sits over the greater trochanter of the femur on the outer side of the hip. The bursa is a fluid-filled sac that cushions the hip tendons and muscles as they glide over the bony prominence.
Trochanteric bursitis is one of the most common causes of lateral hip pain, but it is frequently part of a broader problem rather than an isolated finding. The gluteus medius and minimus tendons pass directly over the greater trochanteric bursa, and tendinopathy or tearing of these tendons — essentially the rotator cuff of the hip — almost always coexists with significant bursitis. Lateral hip pain from trochanteric bursitis must also be distinguished from the deep posterior pain of ischiofemoral impingement and the groin-predominant pain of a hip labral tear, as these conditions require very different treatments. In runners and cyclists, osteitis pubis and femoral neck stress reactions can coexist with trochanteric bursitis as part of a broader overuse syndrome.
Causes
Overuse and repetitive motion.
Repetitive activities such as running, cycling, stair climbing, and prolonged standing produce repeated friction and compression of the bursa and overlying gluteal tendons as they slide over the greater trochanteric facets with each hip movement cycle. Trochanteric bursitis is almost universally associated with gluteal tendinopathy — the tendons of the gluteus medius and minimus attach directly to the greater trochanter and are subject to the same compressive and shear forces as the bursa. In many patients, what presents clinically as "trochanteric bursitis" is primarily a gluteal tendon degenerative condition with secondary bursal irritation rather than primary bursal inflammation.
Other causes.
Direct trauma from a fall onto the lateral hip can acutely inflame the bursa. Prior hip surgery — including total hip arthroplasty — can alter the biomechanics of the greater trochanteric region and predispose to bursitis. Leg length discrepancy, iliotibial (IT) band tightness and snapping, excessive hip adduction during gait (crossover running pattern), lumbar spine disease with altered gait mechanics, and inflammatory conditions such as rheumatoid arthritis are all recognized contributing factors. The condition is significantly more common in middle-aged and older women — likely reflecting the combination of wider pelvis mechanics, hormonal influences on tendon integrity, and a higher prevalence of IT band tightness.
Symptoms
Patients typically describe a sharp or aching pain over the outer hip — directly over the bony prominence of the greater trochanter — that may radiate down the outside of the thigh toward the knee. This lateral radiation pattern can be confused with IT band syndrome or lateral knee pain. Pain is characteristically worse when lying on the affected side at night — often the presenting complaint that brings patients to medical attention — and with activities that load the lateral hip including stair climbing, rising from a low chair, prolonged walking, and crossing the legs. Tenderness that can be reproduced by pressing directly over the greater trochanter is the most reliable clinical finding and distinguishes trochanteric bursitis from deeper hip joint pathology, which typically does not produce surface tenderness.
Diagnosis
A physical exam reveals exquisite point tenderness directly over the greater trochanter, reproducible pain with resisted hip abduction and external rotation, and often a positive Trendelenburg sign reflecting underlying gluteus medius weakness. A single-leg stance test — asking the patient to stand on the affected leg for 30 seconds — may reproduce symptoms and demonstrate pelvic drop. X-rays exclude bony pathology such as trochanteric fracture or calcification but do not evaluate the soft tissues. An MRI is the definitive imaging study, confirming bursal fluid and inflammation on fluid-sensitive sequences, characterizing the integrity of the gluteus medius and minimus tendons — including the presence and size of any partial or full-thickness tears — and excluding other causes of lateral hip pain such as femoral neck stress reaction and intra-articular labral pathology. The distinction between isolated bursitis, tendinopathy, and tendon tearing on MRI directly influences treatment — tendon tears require targeted repair rather than bursal injection alone.
Classification
Lateral hip pain at the greater trochanter is classified under the broader diagnosis of greater trochanteric pain syndrome (GTPS), with the MRI findings determining the specific subtype.
- Isolated trochanteric bursitis: Bursal fluid and inflammation on MRI with intact gluteal tendons. Most favorable response to corticosteroid injection and physical therapy.
- Gluteal tendinopathy: Tendon degeneration, thickening, or intrasubstance signal change on MRI without a discrete tear. Often the dominant pathology in chronic cases, with bursitis secondary to the tendon abnormality. Responds better to load management and PRP than to corticosteroid injection alone.
- Gluteal tendon tear (partial or full-thickness): Discrete tendon discontinuity on MRI. Partial tears are managed conservatively in most patients; large or complete tears in young, active patients may require surgical repair.
- Greater trochanteric pain syndrome (GTPS): Umbrella diagnosis encompassing bursitis, tendinopathy, and external snapping hip (coxa saltans externa) — IT band snapping over the greater trochanter. All components should be identified on MRI and addressed in the treatment plan.
Treatments
Treatment depends on the MRI subtype, severity and duration of symptoms, and whether associated tendon damage is present. The cornerstone of all treatment is load management — reducing the compressive and shear forces on the greater trochanteric region while rebuilding tendon and abductor muscle capacity.
Conservative care: Activity modification — specifically avoiding positions that compress the lateral hip (crossing legs, lying directly on the side, low seating) and reducing high-impact loading — is the first and most important intervention. Ice and anti-inflammatory medications manage acute pain. Physical therapy focused on progressive hip abductor and external rotator strengthening, IT band flexibility, and gait retraining to eliminate hip adduction patterns is highly effective and produces durable results when followed consistently. A graduated loading program rather than complete rest produces better tendon recovery outcomes — complete unloading leads to further tendon degeneration.
Injections
When conservative measures alone are insufficient, a corticosteroid injection into the trochanteric bursa under ultrasound guidance provides significant short-term pain relief — most effective for isolated bursitis. For cases with predominant gluteal tendinopathy, corticosteroids have a less durable effect and may weaken tendon tissue with repeated use; platelet-rich plasma (PRP) injection is a more appropriate option, promoting tendon healing through growth factor delivery. Image guidance ensures the injection reaches the correct anatomic target and avoids inadvertent tendon injection.
Surgery
Surgery is reserved for patients with persistent, functionally limiting symptoms despite at least 6 months of comprehensive conservative treatment. Arthroscopic or endoscopic bursectomy removes the inflamed bursal tissue, and IT band release or lengthening is performed if snapping is contributing. When a significant gluteal tendon tear is present — particularly a full-thickness tear of the gluteus medius — open or arthroscopic tendon repair with suture anchors is performed, analogous to a rotator cuff repair in the shoulder. After surgery, a protected rehabilitation program progressing through range of motion, strengthening, and functional retraining over 4–6 months is essential for a full recovery.
Get an MRI to Confirm Your Diagnosis
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