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  • Hip greater trochanteric bursitis
  • Greater trochanteric pain syndrome (GTPS)
  • Hip abductor pain syndrome

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  • 726.5 Enthesopathy of the hip region

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  • M70.6 Trochanteric bursitis

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Description

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  • Pain over the greater trochanter, lateral thigh pain2
  • Differs from hip pointer (iliac crest contusion) based on location of injury/trauma
  • Pain on transition between standing and lying down
  • Direct trauma
    • Fall onto lateral hip
    • Direct blow
  • Idiopathic2

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Essentials of Diagnosis

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  • Friction between iliotibial band (ITB), bursa, and trochanter
    • Pressure from greater trochanter and overlying muscles compress bursa into the trochanter, creating pain and discomfort
    • Bursa is next to femur, between 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 appear later

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Demographics

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  • Common in runners

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Signs and Symptoms

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  • Audible or palpable snapping over lateral hip3
  • Burning sensation
  • Point tender with palpation
  • Radicular pain into buttock, down leg into knee
  • Limited motion adduction and internal rotation
  • Pain with rising up and down from chair
  • Swelling
  • Redness
  • Ecchymosis, if caused by direct trauma3
  • During static weight bearing, patient may rotate femur to clear ITB from the greater trochanter
  • Painful resisted hip external rotation
  • 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 (ADLs, physical and athletic activities)
  • Difficulty sleeping on affected side

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Possible Contributing Causes

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  • Trauma
  • Poor lower-extremity mechanics, (e.g., running mechanics, pronators)
  • Tight hip adductors
  • Hip musculature imbalance
  • ITB tightness
  • Weak hip abductors
  • Sacral dysfunction
  • OA of hip or lumbar spine
  • Degenerative disk disease/low back pain
  • Rheumatoid arthritis
  • Leg-length discrepancy (true or perceived)
  • Fibromyalgia
  • Pes planus

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  • Osteoarthritis (OA)
  • ITB syndrome
  • Femoral head osteonecrosis
  • Femoral-neck stress fracture
  • Lumbar disk herniation
  • Lumbar degenerative disc disease
  • Lumbar spinal stenosis
  • Hip arthritis
  • Septic arthritis
  • Hip avascular necrosis
  • Lumbar facet syndrome
  • Lumbar spine compression fracture
  • Abductor muscle strain
  • Ischial or iliopectineal bursitis
  • Tendinitis of gluteus medius, gluteus maximus
  • Snapping hip syndrome
  • Sciatica
  • Metastatic tumor
  • Inguinal and femoral hernia

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Imaging

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  • Radiographs of spine and hip
  • MRI for soft tissue and fracture
  • Bone scan for stress fracture and hip necrosis
  • Diagnostic ultrasound

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  • Positive Ober’s test2
  • Radiographs negative

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Medications

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  • To hospital for imaging
  • To physician for medication, anti-inflammatory, corticosteroid injection
  • To surgeon for surgical ...

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