Trochanteric bursitis and lateral hip pain — causes and treatment

Pain on the outer side of the hip is extremely common, and it is frequently labelled “trochanteric bursitis”. The reality is a little more nuanced — in many people the problem lies in the tendons rather than the bursa — and understanding the true cause leads to better treatment.

Where the pain is felt

This condition causes pain over the bony point on the outer side of the hip, called the greater trochanter. The pain is often worse when lying on that side at night, when getting up from a chair, climbing stairs, or after walking. It is felt on the side of the hip, in contrast to hip joint arthritis, which more typically causes pain in the groin.

Pain on the side of the hip usually points to the gluteal tendons; pain in the groin more often points to the hip joint itself.

What is actually going on

The term “bursitis” suggests inflammation of the bursa, a small fluid-filled cushion over the trochanter. While the bursa can be involved, current understanding is that the main problem in most cases is the gluteal tendons — the tendons of the muscles that attach there — which can become degenerate, irritated or partially torn. The condition is sometimes called greater trochanteric pain syndrome to reflect this.

Who gets it?

It is more common in women and in middle age and beyond. It can be triggered by a change in activity, weakness of the hip muscles, or altered walking patterns. It also commonly coexists with lower back problems and, sometimes, with hip arthritis.

Diagnosis

The diagnosis is usually made from the history and examination, with tenderness directly over the trochanter. Imaging — an ultrasound or MRI — can confirm the state of the tendons and bursa and is useful when the diagnosis is unclear or symptoms are not settling.

Treatment

The mainstay of treatment is non-surgical and is effective for most patients. A targeted physiotherapy programme to strengthen the gluteal muscles and correct loading is the cornerstone. Activity modification, addressing contributing factors such as back problems, and relative rest from aggravating activities all help. A corticosteroid injection can settle a painful flare in some cases, though its benefit tends to be temporary and it is not a substitute for strengthening. In a minority of patients with significant gluteal tendon tears that do not respond, surgical repair may be considered.

The bottom line

Lateral hip pain is common, usually a tendon problem rather than simple bursitis, and usually treatable without surgery. Getting the diagnosis right — and committing to a proper strengthening programme — is the key to lasting relief.