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180: GREATER TROCHANTERIC BURSITIS

Jason C. Craddock, EdD, ATC, CSCS; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Hip greater trochanteric bursitis

  • Greater trochanteric pain syndrome (GTPS)

  • Hip abductor pain syndrome

ICD-9-CM CODE

  • 726.5 Enthesopathy of the hip region

ICD-10-CM CODE

  • M70.6 Trochanteric bursitis

PREFERRED PRACTICE PATTERN

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation1

PATIENT PRESENTATION

A 15-year-old female soccer player complains of left hip pain. After taking a thorough history, it is noted that formal team conditioning practice started 2 weeks ago and she has been running on the road in the evenings after practice in efforts to get into “shape.” The athlete complains of pain at the beginning of practice that somewhat dissipates during practice but then returns with greater intensity after practice is over. She also mentioned that there is increased pain when she puts more weight on the left leg.

KEY FEATURES

Description

  • 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

Essentials of Diagnosis

  • Diagnostic ultrasound can detect bursitis verse gluteal tendinosis, gluteal tears and thickening of the ITB tendon

  • 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

FIGURE 180-1

The bursae of the hip. (Reproduced with permission from Simon RR, Sherman SC, Koenigsknecht SJ. Emergency Orthopedics, The Extremities. 5th ed. © 2007, McGraw-Hill Inc., New York.)

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General Considerations

  • Concern regarding possible slipped growth plate in younger children

  • Stress fractures or blood-supply disruption to the hip may appear later

FIGURE 180-2

Lesions of the Hip and Groin. (A) Trendelenburg sign. When the patient stands on one foot, the buttock falls. (B) Subinguinal painless swelling. Swelling below the inguinal ligament may be either a psoas abscess or an effusion in the psoas bursa. (From LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Demographics

  • Common in runners

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Audible or palpable snapping over lateral hip3

  • Burning sensation

  • Point tender with palpation

  • Radicular pain into buttock, down leg ...

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