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Condition/Disorder Synonyms

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  • Hip greater trochanteric bursitis

  • Greater trochanteric pain syndrome (GTPS)

  • Hip abductor pain syndrome

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ICD-9-CM Code

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  • 726.5 Enthesopathy of the hip region

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ICD-10-CM Code

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  • M70.6 Trochanteric bursitis

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Preffered Practice Pattern

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Key Features

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Description

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  • Pain over the greater trochanter, lateral thigh pain2

  • Differs from a hip pointer (iliac crest contusion) based on the location of injury/trauma

  • Pain transitioning from standing to lying down to standing

  • Direct trauma

    • - Falling onto lateral hip

    • - Direct blow

  • Idiopathic2

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Essentials of Diagnosis

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  • Friction between the iliotibial band (ITB), bursa, and trochanter

    • - Pressure from the greater trochanter and overlying muscles compress the bursa into the trochanter creating pain and discomfort.

    • - Bursa is next to the femur between the insertion of the gluteus medius and gluteus minimus.

    • - Functions as a shock absorber.

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General Considerations

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  • Concern regarding possible slipped growth plate in younger children.

  • Stress fractures or blood supply disruption to the hip may show up later.

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Demographics

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  • Common in runners

  • Incidence of 1.8 cases per 1000 persons per year3

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Clinical Findings

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Signs/Symptoms

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  • Audible/palpable snapping over lateral hip4

  • Burning sensation

  • Point tender with palpation5

  • Radicular pain into buttock and down the leg into knee

  • Limited motion adduction and internal rotation

  • Pain with rising up and down from chair

  • Swelling in the acute phase6

  • Redness in the acute phase6

  • Ecchymosis: If caused by direct trauma4

  • During static weight bearing, patient may rotate the femur to clear the ITB from the greater trochanter

  • Painful resisted hip external rotation (ER)

  • Painful passive stretching of ITB, hip extension/flexion

  • Weakness in hip abduction

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Functional Implications

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  • Antalgic gait

  • Painful end ranges during ambulation

  • Patient may increase weight bearing on the unaffected extremity

  • Pain and weakness as ITB passes over greater trochanter

  • Pain-limited functional activities (activities of daily living [ADLs], physical and athletic activities)

  • Difficulty sleeping on that side

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Possible Contributing Causes

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  • Trauma

  • Poor lower extremity mechanics, that is, running mechanics, (pronators)

  • Tight hip adductors

  • Hip musculature imbalance

  • ITB tightness7

  • Weak hip abductors

  • Sacral dysfunction

  • Osteoarthritis (OA) of hips, knees, or lumbar spine7

  • Degenerative disc disease (DDD)/low-back pain/lumbopelvic dysfunction

  • Rheumatoid arthritis

  • Leg length discrepancy (true or apparent)

  • Fibromyalgia

  • Pes planus

  • Wider pelvis/hips in females7

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Differential Diagnosis

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  • OA

  • ITB syndrome

  • Torn labrum of the hip, intra-articular

  • Femoral head osteonecrosis

  • Femoral neck stress fracture

  • Lumbar disk herniation/radiculopathy6

  • Lumbar DDD

  • Lumbar ...

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