Trochanteric Bursitis: Difference between revisions

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<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox">
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'''Original Editors ''' - [[User:Emy Van Rode|Emy Van Rode]]  
'''Original Editors ''' - [[User:Emy Van Rode|Emy Van Rode]] as part of the [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]


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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}    
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== Search Strategy  ==


<u>'''Databases'''</u><br>
== Definition/Description  ==


*Pubmed
Trochanteric [[bursitis]] was first described in 1923 <ref name=":7">Hilligsøe M, Rathleff MS, Olesen JL. [https://vbn.aau.dk/ws/files/312074292/Study_Protocol_Ultrasound_Definitions_and_Findings_in_Greater_Trochanteric_Pain_Syndrome_A_Systematic_Review_Version_2.pdf Ultrasound definitions and findings in greater trochanteric pain syndrome: a systematic review.] Ultrasound in Medicine & Biology. 2020 Jul 1;46(7):1584-98.</ref><ref name=":8">Board TN, Hughes SJ, Freemont AJ. [https://www.researchgate.net/profile/Tim-Board/publication/265419776_Trochanteric_Bursitis_The_Last_Great_Misnomer/links/54d285120cf25017917e624c/Trochanteric-Bursitis-The-Last-Great-Misnomer.pdf Trochanteric bursitis: the last great misnomer]. Hip international. 2014 Nov;24(6):610-5.</ref>and was used to describe lateral [[hip]] [[Pain Behaviours|pain]]<ref name=":8" /><ref name=":9">Lange J, Tvedesøe C, Lund B, Bohn MB. [https://ugeskriftet.dk/files/scientific_article_files/2022-06/a09210714_web.pdf Low prevalence of trochanteric bursitis in patients with refractory lateral hip pain]. Danish medical journal. 2022 Jun 15;69(7):A09210714.</ref> thought to be caused by inflammation of the trochanteric bursa.
*Web of Knowledge
*Google scholar
*Medscape
*VUBis


<u>'''Search words'''</u>  
The continued use of trochanteric bursitis for lateral hip pain is however unsuitable as bursitis implies [[Inflammation Acute and Chronic|inflammation]] yet three of the four cardinal inflammatory signs, namely rubor, tumour and calor<ref name=":7" /><ref name=":8" /> <ref name=":10">Reid D. T[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761624/ he management of greater trochanteric pain syndrome: a systematic literature review.] Journal of Orthopaedics. 2016 Mar 1;13(1):15-28.</ref>are rarely present<ref name=":7" /><ref name=":8" />.  Studies have revealed that trochanteric bursitis is rarely present in isolation <ref name=":9" /><ref>Long SS, Surrey DE, Nazarian LN. [https://www.researchgate.net/publication/258067149_Sonography_of_Greater_Trochanteric_Pain_Syndrome_and_the_Rarity_of_Primary_Bursitis Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis]. American Journal of Roentgenology. 2013 Nov;201(5):1083-6.</ref> and that there is a low prevalence of trochanteric bursa inflammation<ref name=":9" /><ref name=":11">Koulischer S, Callewier A, Zorman D. [http://actaorthopaedica.be/assets/2500/02-Koulisher.pdf Management of greater trochanteric pain syndrome: a systematic review.] Acta Orthop Belg. 2017 Jun 1;83(2):205-14.</ref> in patients with lateral hip pain. More recently it has become clear that gluteal tendon pathology ([[Gluteal Tendinopathy|gluteal tendinopathy]] or gluteal tendon tears<ref name=":7" /><ref name=":8" /><ref name=":9" /><ref name=":12">Speers CJ, Bhogal GS. [https://bjgp.org/content/bjgp/67/663/479.full.pdf Greater trochanteric pain syndrome: a review of diagnosis and management in general practice]. British Journal of General Practice. 2017 Oct 1;67(663):479-80.</ref><ref name=":13">Lin CY, Fredericson M. [https://www.researchgate.net/profile/Michael-Fredericson/publication/272409750_Greater_Trochanteric_Pain_Syndrome_An_Update_on_Diagnosis_and_Management/links/5b16dc4e45851547bba30c6b/Greater-Trochanteric-Pain-Syndrome-An-Update-on-Diagnosis-and-Management.pdf Greater trochanteric pain syndrome: an update on diagnosis and management.] Current Physical Medicine and Rehabilitation Reports. 2015 Mar;3(1):60-6.</ref>or [[Snapping Hip and Trochanteric Bursitis|external coxa saltans]] <ref name=":14">Khoury AN, Brooke K, Helal A, Bishop B, Erickson L, Palmer IJ,  et al. [https://academic.oup.com/jhps/article/5/3/296/5068229?login=true Proximal iliotibial band thickness as a cause for recalcitrant greater trochanteric pain syndrome]. Journal of Hip Preservation Surgery. 2018 Aug;5(3):296-300.</ref><ref name=":10" /> is more likely the primary cause of the lateral hip pain and that associated trochanteric bursitis can be present<ref name=":7" /><ref name=":8" /><ref name=":9" /><ref name=":12" /><ref name=":13" />.  The gluteal tendon pathology or external coxa saltans with the possible associated trochanteric bursitis is now referred to as [[Greater Trochanteric Pain Syndrome|greater trochanteric pain syndrome (GTPS)]]<ref name=":8" /><ref name=":11" /><ref name=":12" /><ref name=":13" />. If there is GTPS and an associated bursitis, the bursitis can occur in the subgluteus maximus (trochanteric bursa), subgluteus medius or subgluteus minimus bursa but it most commonly occurs in the trochanteric bursa<ref name=":13" />.


*Hip bursitis  
In the rarer cases of isolated trochanteric bursitis, the causes could include:
*Trochanteric Bursitis
*Greater trochanteric pain syndrome


== Definition/Description<br>  ==
* [[Sepsis|Septic]] trochanteric [[bursitis]]


&nbsp;For the definition of bursitis: [http://www.physio-pedia.com/Bursitis Bursitis].<br>In the hip region there are 4 different types of hip bursitis: Trochanteric bursitis, [http://www.physio-pedia.com/Iliopsoas_Bursitis iliopsoas bursitis], [http://www.physio-pedia.com/Gluteal_Bursitis gluteal bursitis] and [http://www.physio-pedia.com/Ischial_Bursitis ischial bursitis]. Trochanteric bursitis is the more common. It is pain over the lateral part of the hip, paraesthesiae in the legs, and tenderness over the iliotibial tract. The term greater trochanteric pain syndrome is now often substituted for trochanteric bursitis.[2] The condition is more prevalent among women than among men. [3] (level of evidence A1) but also among patients with coexisting low back pain, [http://www.physio-pedia.com/Osteoarthritis osteoarthritis], iliotibial band tenderness, and obesity.<br>In this article, the condition trochanteric bursitis will be treated<br><br>
If inflammatory signs such as redness, swelling and warmth are present, [[Septic (Infectious) Arthritis|septic arthritis]] should be suspected<ref name=":13" /><ref name=":15">Truong J, Mabrouk A, Ashurst JV. [https://www.ncbi.nlm.nih.gov/books/NBK470331/ Septic Bursitis.] InStatPearls [Internet] 2021 Sep 14. StatPearls Publishing.</ref>.  Sometimes septic bursitis can be present without these inflammatory signs and then aspiration is needed to confirm the diagnosis<ref name=":15" />. It can be acute, sub-acute or chronic<ref name=":15" />.


== Clinically Relevant Anatomy  ==
* Other causes of  trochanteric bursitis


The trochanteric bursae can be named as a cause of lateral hip pain, they lie above the lateral aspects of the greater femoral trochanter. There are four bursae that surround the greater trochanter. Three of them are present among most individuals. Bursae provides cushioning between bony prominences and the surrounding soft tissues. In this case they provide cushioning for the gluteus tendons, iliotibial band and tensor fascia latae.
Certain auto-immune diseases such as [[Rheumatoid Arthritis|rheumatoid arthritis (RA)]] can lead to trochanteric bursitis<ref>Suh JY, Park SY, Koh SH, Lee IJ, Lee K. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446489/ Unusual, but important, peri-and extra-articular manifestations of rheumatoid arthritis: a pictorial essay]. Ultrasonography. 2021 Oct;40(4):602.</ref> as well as crystal arthropathies such as [[gout]]<ref name=":13" />. Direct trauma could potentially also lead to isolated trochanteric bursitis. Isolated trochanteric bursitis due to repetitive rubbing/friction is possible<ref name=":14" /> but is very rare<ref name=":9" />.


Anatomically, there are two major bursitis and one minor that surround the greater trochanter.<br>The minor bursitis is called the gluteus minimus bursae, it is located cranial and ventral to the greater trochanter.The less important bursitis is the gluteus medius, this in contrast with the gluteus maximus. This last one is lateral to the greater trochanter and is situated between the gluteus medius tendon and the gluteus maximus muscle. It lies deep to the converging fibres of the tensor fascia latae. The iliotibial tract is formed by the gluteus maximus muscle and fascia. These powerful converging fibres are thus separated from the greater trochanter and from the attachment of the vastus lateralis muscle, situated by the bursa. In the illness greater trochanteric pain syndrome we mostly talk about the subgluteus maximus that is incriminated.
== Clinically Relevant Anatomy ==
[[File:Trochanteric_Bursitis.jpg|right|150x150px]]
A bursa is a sac that usually contains a small amount of fluid and functions as a friction-reducing structure between two anatomical structures, e.g. bone and tendon<ref name=":13" /><ref name=":16">Ivanoski S, Nikodinovska VV. [https://sciendo.com/it/article/10.15557/jou.2019.0032 Sonographic assessment of the anatomy and common pathologies of clinically important bursae]. Journal of Ultrasonography. 2019 Jan 1;19(78):212-21.</ref>. Bursitis is characterised by soft-tissue swelling, localised pain, synovial thickening and increased fluid in the bursa<ref name=":16" />.  


[4] (Level of Evidence 1A)<br>[12] (Level of Evidence 3B)<br>[13] (Level of Evidence 5)<br>[14] (Level of Evidence 2C)<br>[15] (Level of Evidence 3A)<br><br>
The trochanteric bursa covers the posterior facet and lies deep into the gluteus maximus muscle. It also lies over the trochanter attachments of gluteus medius, gluteus minimus and vastus lateralis<ref name=":13" />. The sub gluteus medius bursa is situated at the lateral and superolateral facets deep to the gluteus medius tendon insertion while the sub gluteus minimus bursa is located between the anterior facet and gluteus minimus tendon<ref name=":13" />.


== Epidemiology /Etiology  ==
== Epidemiology /Etiology  ==
When there is GTPS with associated  trochanteric bursitis, the following are possible causes/contributing factors:


The prevalence of unilateral GTPS is 15.0% among women and 8.5% among men, and that of bilateral GTPS is 6.6% among women and 1.9% among men(16). In a study by Lievense et al. 1.8 in 1000 patients in primary care had the annual incidence of trochanteric pain (18) .The study also found out that trochanteric bursitis is more prevalent among females (80%) than among males. (level of evidence 1A)<br> <br>The etiology thought that trochanteric bursitis is caused by inflammation of the subgluteus maximus bursa. <br>Trochanteric bursitis can develop as a complication of arthroscopic surgery of the hip (in an estimated 1.4% of all cases) (17) or sometimes it can develop spontaneously without apparent negative factors (precipitating factors).<br> <br>There are many factors that may cause greater trochanter pain syndrome:<br>- trauma:When the patient lands on the lateral hip region or bumps the hip into an object. Such trauma is caused by:<br>*[http://www.physio-pedia.com/Iliotibial_Band_Syndrome ITBS]: iliotibial band syndrome. It is the most common cause of lateral knee pain(30).The frictions between the lateral epicondyle and the iliotibial tract is through the repetitive motion. It is an overuse injury in combination with the weakness of hip abductor muscles(31).<br> * Dysfunction of the insertion of gluteus medius<br>* or both, during frequent training on hard or banked running surface
* direct trauma
* mechanical overload<ref name=":10" /><ref name=":0">Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. [https://www.researchgate.net/profile/Bill-Vicenzino/publication/276362252_Gluteal_Tendinopathy_A_Review_of_Mechanisms_Assessment_and_Management/links/555db77208ae8c0cab2af237/Gluteal-Tendinopathy-A-Review-of-Mechanisms-Assessment-and-Management.pdf Gluteal tendinopathy: a review of mechanisms, assessment and management.] Sports Medicine. 2015 Aug;45(8):1107-19.</ref>
* overuse<ref name=":10" />
* compression of the tendon (and bursa)<ref name=":0" />
* female gender<ref name=":13" />
* poor pelvic control or weak hip abductors<ref name=":0" />
* external coxa saltans<ref name=":10" /><ref name=":14" />
* [[Gluteus Medius|Gluteus medius]] <ref name=":1">Pascual-Garrido C, Schwabe MT, Chahla J, Haneda M. [https://www.sciencedirect.com/science/article/pii/S2212628719301549 Surgical treatment of gluteus medius tears augmented with allograft human dermis]. Arthroscopy techniques. 2019 Nov 1;8(11):e1379-87.</ref> and [[Gluteus Minimus|minimus]] tears (degenerative or traumatic)
* [[Obesity]]<ref>Bird PA, Oakley SP, Shnier R, Kirkham BW. [https://onlinelibrary.wiley.com/doi/epdf/10.1002/1529-0131%28200109%2944%3A9%3C2138%3A%3AAID-ART367%3E3.0.CO%3B2-M Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome]. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2001 Sep;44(9):2138-45.</ref>


- Hip osteoarthritis<br>- Leg length differences (4)<br>-Stress on the soft tissues: it is a result of an abnormal or poorly positioned joint or bone, such as differences in the length of the legs or arthritis in a joint.<br>-Previous surgery: when it is localized around the hip or prosthetic implants in the hip.<br>- Incorrect posture: this condition is the result of[http://www.physio-pedia.com/Scoliosis scoliosis], arthritis of the lumbar (lower) spine and other spine problems.<br>- Lumbar spondylosis<br>- Sacroiliac disorder<br>- Lower leg gait<br>- Excessive or rapidly increased mileage<br>- Poorly cushioned shoes<br>- Excessive pronation<br>- Increased BMI(4)<br>
GTPS is more common in women in their 4th to 6th decades of life<ref name=":7" /><ref name=":12" />. A recent study found that only 2% of women had isolated trochanteric bursitis, while 25% had hip abductor tendon pathology with an associated trochanteric bursitis<ref name=":9" />.


== Characteristics/Clinical Presentation  ==
Septic bursitis occurs when bacteria is introduced into the bursa<ref name=":1" /> and can occur due to:


Following characteristics may occur:<br>- Chronic pain and/or hip tenderness in the lateral aspect of the hip that may radiate down the thigh.22<br>  More specifically while palpaiting superior and posterior of the greater trochanter.<br>  Maximum tenderness at the insertion of the M. Gluteus maximus<br>  Can also be felt over the iliotibial tract [4]<br>- Pain limits the strength and makes the legs feel weak<br>- Pain in the area of the greater trochanter whilst walking or running. It can be felt over the lateral aspect of the leg until the knee<br>- Stair-climbing is most painful [11]<br>- Patient is not able to lie down on the affected side<br>  Development of pain-related sleep disturbance [2]<br>- Lower back pain can be related to Trochanteric Bursitis [6]<br>- Weakness of the hip-abductors<br>  Resistance test can cause tenderness - Pain and tenderness can arise while resisting external rotation<br>- A snap felt in the lateral aspect of the hip [1] (level of evidence A1)<br>[22] (Level of Evidence 5)<br>
* [[Tuberculosis]] infection (less than 2% of musculoskeletal tuberculosis presents as septic trochanteric bursitis)<ref name=":10" /><ref name=":13" /><ref name=":2">Vlaic J, Pavic I, Batos AT, Zmak L, Kruslin B. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343840/ Neglected tuberculous trochanteric bursitis in an adolescent girl: A case report and literature review]. Joint diseases and related surgery. 2021 Aug;32(2):536.</ref>
* Direct puncture of the skin<ref name=":15" />
* Micro-trauma<ref name=":15" />
* [[Cellulitis]] of the skin that is adjacent to the bursa<ref name=":15" />


== Differential Diagnosis  ==
Most cases of acute septic bursitis involve Staphylococcus aureus, followed by Streptococcus<ref name=":15" /> . Atypical mycobacteria or fungi are associated with chronic septic bursitis<ref name=":15" />. Septic bursitis, in general, is more common in men around the age of 50 years<ref name=":15" />. People who are more susceptible to septic arthritis, in general, include those with inflammatory arthritis (e.g. RA) and those with crystal arthropathies like [[gout]] (19).


Trochanteric bursitis is one of the pathologies that can cause lateral hip pain. The other pathologies that are associated with this pain could be: <br>• Gluteal tendonitis (gluteus medius or minimus muscles)<br>• Gluteal muscle dysfunction (atrophy, tear,…) <br>• Iliotibial band disorders ( Snapping Hip syndrome) <br>• Femoral Fractures (Femoral neck stress fractur) <br>• Lumbar spine disease (including zygapophysical joints, sacroiliac joint, and intervertebral discs and ligaments) <br>• Ipsilateral and/or contralateral hip arthritis. <br>• Pain radiation patterns may complicate the diagnosis of GTPS because of anatomical overlap with the iliotibial tract and mid-lumbar dermatomes <br>• damage to the nerve supply of surrounding structures may elicit neuropathic symptoms that can stimulate GTPS <br>• chronic mechanical low back pain <br>• [http://www.physio-pedia.com/Rheumatoid_Arthritis Rheumatoid arthritis] <br>• leg length descrepancy <br>• Post surgical lumbar disk desease <br>• Radiculopthy or other neurologic sequelae <br>• [http://www.physio-pedia.com/Obesity Obesity] <br>• [http://www.physio-pedia.com/Fibromyalgia Fibromyalgia]<br>[6],[7](level of evidence 1A)<br>[4] (Level of Evidence 1A)<br>
== Characteristics/Clinical Presentation  ==
 
* Lateral hip pain<ref name=":8" /><ref name=":13" /><ref name=":3">Grimaldi A, Fearon A. [https://www.jospt.org/doi/pdf/10.2519/jospt.2015.5829 Gluteal tendinopathy: integrating pathomechanics and clinical features in its management.] journal of orthopaedic & sports physical therapy. 2015 Nov;45(11):910-22.</ref>
* Pain to the lateral thigh and knee<ref name=":8" /><ref name=":13" /><ref name=":3" />
* Local tenderness over the greater trochanter<ref name=":8" /><ref name=":13" /><ref name=":3" />
* Pain with side-lying on the affected side<ref name=":8" /><ref name=":13" /><ref name=":3" /> and sometimes when lying on the unaffected side too due to hip adduction on the affected side<ref name=":3" />
* Pain with weight-bearing activities<ref name=":8" /><ref name=":13" /><ref name=":3" />
* Pain with sitting crossed-legged<ref name=":3" />
* Pain with prolonged sitting<ref name=":8" /><ref name=":13" />


== Diagnostic Procedures  ==
== Diagnostic Procedures  ==


• Gluteus medius tendonitis [3]<br>• Iliotibial band disorders ([http://www.physio-pedia.com/Snapping_Hip_Syndrome Snapping_Hip]): <br>Confirmed with positive [http://www.physio-pedia.com/Ober's_Test Ober's_Test]. [6]<br>• Gluteal medius muscle disfunction: <br>Confirmed with positive [http://www.physio-pedia.com/Trendelenburg_Test Trendelenburg_Test]. Tenderness involving the whole muscle instead of point tenderness. An MRI can reveal a tear in the muscle. Iliotibial band disorders, Gluteal muscle atrophy and hip tendonitis are hard to differentiate from a trochanteric bursitis because they could be in relation with, or even be the cause of this disorder. For instance, while testing for Iliotibial band disorders or gluteal muscle atrophy, symptoms will also occur when suffering from a bursitis. An MRI must give more specific information. [6] <br>• Femoral neck stress fracture: <br>The hop test on one leg will cause pain in the ipsilateral groin region in case of a femoral neck stress fracture. [1]<br>• Lumbar spine disease and ipsilateral hip pain :<br>Differentiated with the[http://www.physio-pedia.com/FABER_Test FABER_Test] [1]<br>(level of evidence A1)<br>
There is no one specific test to confirm GTPS. Please see the [[Greater Trochanteric Pain Syndrome|GTPS]] page for a complete list of the tests that can be used. Concerning imaging, ultrasound can be used but is only indicated if conservative management has failed<ref name=":13" /><ref name=":3" />; if the diagnosis is unclear<ref name=":13" /><ref name=":3" /> or if the primary pathology is thought to be a gluteal tear<ref name=":13" />. MRI can be used for differential diagnosis<ref name=":7" /><ref name=":3" />.


== Outcome Measures  ==
In septic arthritis, [[antibiotics]] should only be started after blood cultures and inflammatory marker investigations have been done and should include white blood count, C-reactive protein and erythrocyte sedimentation<ref name=":15" />. Currently, the gold standard for diagnosis is aspiration and analysis of the bursal fluid<ref name=":15" />. Uric acid and rheumatoid factor should be ordered if one of these is suspected<ref name=":15" />. Imaging does not help diagnose septic arthritis and should only be conducted if other pathology, such as septic arthritis, is suspected<ref name=":15" />.


add links to outcome measures here (also see [[Outcome Measures|Outcome Measures Database]])
== Differential Diagnosis ==
Multiple structures can present as lateral hip pain. In the absence of inflammatory signs, differential diagnosis can include:


== Physical Examination  ==
* GTPS, including external [[Snapping Hip Syndrome|coxa saltans]]<ref name=":10" /><ref name=":14" />, [[Gluteal Tendinopathy|gluteal tendinopathy]]<ref name=":7" /><ref name=":8" /><ref name=":9" />and gluteal tears<ref name=":7" /><ref name=":8" /><ref name=":9" />.
* [[Referred Pain|Referred pain]] from the lumbar spine<ref name=":13" /><ref name=":3" />
* [https://www.physio-pedia.com/Hip_Osteoarthritis?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal Hip osteoarthritis]<ref name=":13" /><ref name=":3" />
* [[Femoroacetabular Impingement|Femoroacetabular impingement]]<ref name=":13" /><ref name=":3" />
* Femoral head stress fracture<ref name=":13" />
* [[Labral Tear|Labral tears]]<ref name=":13" /><ref name=":3" />
* Bony metastasis<ref name=":3" />
* [[Femoral Neck Fractures|Neck-of-femur fracture]]<ref name=":3" />
* [[Rheumatoid Arthritis|Rheumatoid arthritis]]<ref name=":3" />
* [[Avascular Necrosis Femoral Head|Femoral head avascular necrosis]]<ref name=":13" />


Physical examination is performed based upon the history of previous injuries and it is used to confirm the source of the pain23 and establish any limitations or deficits that the patient might have. It also assesses the underlying disorder or anatomical impairment that may cause a bursitis. <br>The physical examination must have a stepwise approach which includes inspection, gait, palpation, Range of motion, muscle strength and the execution of special tests.23 <br>The first part is the inspection. The most important aspect of inspection is the patient’s posture in a seated and upright position. 24 The patient with an irritated hip will tend to stand with the joint slightly flexed. In a seated position: slouching and leaning to the uninvolved slide allows the hip to seek a slightly less flexed position. The observation is also focused on the asymmetry, the gross atrophy, the spinal alignment or the pelvic skewness. <br>While observing the gait, one should look at leg length discrepancy, weakness and heel strike which contributes to the function of the gluteus maximus. 25<br>Bursae pain may be detected by palpation. We perform palpation to assess sources of the hip pain. The palpation starts with joint tenderness on the proximal and distal area of the hip. Also each part of the body that is associated with this injury must be assessed, e.g.: the bone, muscle, ligaments, etc. It is important to check the lumbar spine, sacroiliac joints, ischium, iliac crest, lateral aspect of the greater trochanteric bursa, muscle bellis and the pubic symphysis. They can determine a potential source of hip symptoms or pain. 23<br>The muscle strength can be assessed by resisted contraction which provokes symptoms. <br>The range of motion should be checked on the actual injured hip as well as on the contralateral hip. An active hip flexion, an internal and external rotation, an abduction and adduction will reproduce pain in the injured 4 area. The range of motion can be identified with several tests: the faber test, Trendelenburg test, Ober’s test, Thomas test and a test whereby the forced flexion combined with internal rotation could be helpful in diagnosing the cause of lateral hip pain. <br>23 level of evidence: 1A<br>24 level of evidence: 1A<br>25 level of evidence: 4<br><br>
If inflammatory signs are present:


== Medical Management <br>  ==
* [[Cellulitis]]<ref name=":15" />
 
* [[Gout]]<ref name=":15" />
There are several ways to treat trochanteric bursitis, depending on whether or not the bursitis has an infection, and whether it is necessary to treat the lesion with or without surgery. <br>Nonsurgical treatment21
* [[Rheumatoid Arthritis|RA]]<ref name=":15" />
 
Aseptic trochanteric bursitis19,20<br>In most cases trochanteric bursitis is treated without surgery. If the pain results from overuse, it is recommended to reduce the activities and change the way of doing them. <br>Furthermore, an exercise program of stretching and strengthening with a physiotherapist will help to bring back full range of motion in the hip, sometimes in combination with anti-inflammatory medications or heat and ice applications to calm inflammation. <br>Improving strength and coordination in the buttock and hip muscles also enable the femur to move in the socket smoothly and can help reduce friction on the bursa.<br>If the above treatment fails to reduce the symptoms, an injection of cortisone into the swollen bursa may be required. This anti-inflammatory injection will reduce the symptoms for months, but it will not cure the problem itself. <br>Septic trochanteric bursitis19,20<br>Infectious trochanteric bursitis does occur, but only in exceptional cases. <br>Further examination of the bursa fluid in the laboratory is necessary to assess which bacteria has caused the infection. Once this is known, an (intravenous) antibiotic therapy can be prescribed. <br>Surgical treatment21<br>Only when the nonsurgical therapy fails, and when the pain is still unbearable, it is recommended to consider surgery. The aim of surgery is to remove the thickened bursa and bone spurs that have arisen on the greater trochanter. Also the large tendon of the gluteus maximus is treated. Some doctors prefer to remove a part of the tendon that rubs against the greater trochanter while others prefer to lengthen the tendon somewhat.
 
[19],[20] (Level of Evidence 5)<br>[21] (Level of Evidence 3A)
 
<br>
 
== Physical Therapy Management <br>  ==
 
There are several treatments that can be used to reduce pain and swelling on a patient with trochanteric bursitis. When pain is the main complaint, we can relieve the pain for other underlying disorders so as to treat them more effectively.<br>Physical therapy is given to improve flexibility, muscle strengthening and joint mechanics. When these aspects are improved, pain will decrease. To heal trochanteric bursitis it is necessary to proceed to infiltration of the bursa with antiphlogistic medication (Corticosteroid-injections). In case of a persistent bursitis, surgery has to be considered as well. Other physical therapy interventions are the use of ultrasound, moist heat and educating the patient on activity modification and correcting possible training errors. <br>The pain of this injury can be reduced in different phases: The first phase is to manage the pain and the inflammation. Pain being the main reason for treatment of the trochanteric bursitis, we can use two common treatments to decrease the pain: the use of ice and non-steroidal anti-inflammatory drugs (NSAIDs). The bursa inflammation can be treated with ice therapy and techniques or exercises that reduce the inflammation structures. There are also other treatments that a physiotherapist can use, e.g.: electrotherapy, acupuncture, taping techniques, soft tissue massage and the temporary use of a mobility aid to off-load the affected side. <br>The second phase is to reinforce the patient’s strength and to restore the normal ROM. The physiotherapist will also to improve the muscle length and resting tension, the proprioception, balance and gait. <br>The next phase of rehabilitation is the restoration of all functions. Many patients catch TB due to their common daily activities like running, walking, … . The goal of the physiotherapist is to provide a specialized program for the patient to improve the movement and to reduce the pain, so that the patient can perform his daily activities. <br>The final phase is to prevent a relapse. It may be as simple as training your abdomines or performing some foot orthotics to address any biomechanical faults in the legs or feet. The therapist will examine your hip stability and function by addressing any deficits in the core strength and balance. Furthermore, he will also teach the patient some self-management techniques. The ultimate goal is to see the patient safely returning to his former sporting or leisure activities!<br>30 level of evidence: 5A<br>31 level of evidence: 1A<br>
 
== Key Research  ==
 
add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>
 
• Pubmed<br>• Medscape<br>• Web of Knowledge<br>• Google scolar<br>• Book: Meeusen R. Heup- en liesletsels, reeks sportrevalidatie. 90-5583-724-5, 2000.
 
== Clinical Bottom Line  ==
 
add text here <br>
 
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
 
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]  
<div class="researchbox">
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>  
</div>
== References  ==


see [[Adding References|adding references tutorial]].  
== Outcome Measures ==
• VISA-G - GTPS-specific outcome measure<ref>Fearon AM, Ganderton C, Scarvell JM, Smith PN, Neeman T, Nash C, et al. [https://www.sciencedirect.com/science/article/abs/pii/S1356689X15000624?via%3Dihub Development and validation of a VISA tendinopathy questionnaire for greater trochanteric pain syndrome, the VISA-G]. Manual therapy. 2015 Dec 1;20(6):805-13.</ref>
== Physiotherapy Management ==


<references />
If trochanteric bursitis is associated with GTPS, the primary problem will need to be addressed. Please see the Physiopedia pages [[Greater Trochanteric Pain Syndrome|GTPS]], [[Gluteal Tendinopathy|gluteal tendinopathy]] and [[Snapping Hip and Trochanteric Bursitis|coxa saltans]] on how to manage the primary problems of the associated trochanteric bursitis.  For the management of specifically the associated bursitis, please see the medical and surgical management below. The videos below simplifies  Trochantric bursitis and it's physiotherapy management
<div class="row">
  <div class="col-md-6"> {{#ev:youtube|Ue9EL8C4R5Y|400}} <div class="text-right"><ref>Zero To Finals. Understanding Trochanteric Bursitis. Available from: http://www.youtube.com/watch?v=Ue9EL8C4R5Y [last accessed 20/01/2024]</ref></div></div>
  <div class="col-md-6"> {{#ev:youtube|lRTEnTT4vlY|400}} <div class="text-right"><ref>HT Physio - Over-Fities- Specialist Physio. 5 Best Exercises to FIX Hip Bursitis (Pain on Outside of Hip). Available from: http://www.youtube.com/watch?v=lRTEnTT4vlY [last accessed 20/01/2024]</ref></div></div>
</div>
== Medical Management ==


<br>1. J. Rosenberg, R. Patel. Hip tendonitis and bursitis review. http://emedicine.medscape.com/article/87169-overview. '''Level of evidence: 1 (A1)'''
[[Corticosteroid Medication|Corticosteroid]] injections can be used to manage the associated bursitis in GTPS but they only provide short-term relief<ref name=":11" />. Platelet-rich plasma (PRP) has also been found to be a feasible option<ref>Jacobson JA, Yablon CM, Henning PT, Kazmers IS, Urquhart A, Hallstrom B, et al. [https://pubmed.ncbi.nlm.nih.gov/27663654/ Greater trochanteric pain syndrome: percutaneous tendon fenestration versus platelet‐rich plasma injection for the treatment of gluteal Tendinosis]. ''Journal of Ultrasound in Medicine'', 2016; ''35''(11):2413-2420.</ref><ref>Ali M, Oderuth E, Atchia I, Malviya A. [https://academic.oup.com/jhps/article/5/3/209/5087803?login=true The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review]. Journal of Hip Preservation Surgery. 2018 Aug;5(3):209-19.</ref>, but it is unknown whether corticosteroid injections or PRP are more effective.


2. Patrick M Foye, MD, Todd P Stitik, MD. Trochanteric bursitis review. http://emedicine.medscape.com/article/87788-overview '''Level of evidence: 1 (A1)'''
[[NSAIDs|Non-steroidal anti-inflammatory drugs]] (NSAIDs) may provide analgesia in the acute phase of GTPS or primary [[bursitis]]. Still, if the GTPS is chronic, NSAIDs are not advised as they may have a detrimental effect on tendon healing<ref name=":13" />.


3. Kyndall L. Boyle, MS, Shane Jansa, MS, Chad Lauseng, MS, Cynthia Lewis. Management of a Woman Diagnosed with Trochanteric Bursitis with the Use of a Protonics® Neuromuscular System. Journal of the Section on Women’s Health, volume 27, No.1, March 2003
Septic bursitis is managed with [[antibiotics]] and if pain management is needed, NSAIDs can be used<ref name=":15" />. If the NSAIDs are insufficient, corticosteroid injection can be used<ref name=":15" />. [[Tuberculosis|TB]] trochanteric bursitis is also managed with antibiotics but treatment continues for much longer, usually 6-18 months<ref name=":5">Ramos-Pascua LR, Carro-Fernández JA, Santos-Sánchez JA, Ramos PC, Díez-Romero LJ, Izquierdo-García FM. [https://synapse.koreamed.org/articles/1050379 Bursectomy, curettage, and chemotherapy in tuberculous trochanteric bursitis.] Clinics in Orthopedic Surgery. 2016 Mar 1;8(1):106-9.</ref>.


4. Bryan S. Williams, Steven P. Cohen: Greater Trochanteric Pain Syndrome: A Review of Anatomy, Diagnosis and Treatment. ANESTHESIA &amp; ANALGESIA, Vol. 108, No. 5, May 2009<br>'''Level of evidence: 1 (A1)'''
== Surgical Management ==
Indications for surgery for septic arthritis include<ref name=":15" /> significant swelling, severe cases that aren’t responding to antibiotics alone or chronic or recurrent cases. Operative interventions include:


5. Dina L. Jones, Diagnosis of Trochanteric Bursitis Versus Femoral Neck Stress Fracture, case report. Physical Therapy. Volume 77. No 1. January 1997
* Suction irrigation<ref name=":15" />
* Needle aspiration in conjunction with systemic antibiotics<ref name=":15" />
* If aspiration fails, incision and drainage<ref name=":15" />
* Bursectomy<ref name=":15" /><ref name=":2" /><ref name=":5" />


6. Katherine Margo, MD, Jonathan Drezner, MD, and Daphne Motzkin, MD. Evaluation and management of hip pain: An algorithmic approach. The journal of family practice, vol 52, No 8, august 2003.
In GTPS, surgical intervention is only indicated if conservative management has failed<ref name=":12" /> or if there is a significant tendon tear<ref name=":3" />. Surgical options for GTPS, without a tendon tear, that are safe and effective include:


7. M. Lequesne, P. Mathieu, V. vuillemin-Bodaghi, H. Bard, P. Dijan. Gluteal Tendinopathy in Refractory Greater Trochanter Pain Syndrome: Diagnostic Value of Two Clinical Tests. Arthritis &amp; Rheumatism, Vol. 59, No. 2, February 15, 2008, pp 241–246<br>'''Level of Evidence: 1 (A1)'''
* Bursectomy<ref>Wiese M, Rubenthaler F, Willburger RE, Fennes S, Haaker R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3456940/pdf/264_2004_Article_569.pdf Early results of endoscopic trochanter bursectomy.] International orthopaedics. 2004 Aug;28(4):218-21.</ref> <ref>Fox JL. [https://www.sciencedirect.com/science/article/abs/pii/S0749806302000397 The role of arthroscopic bursectomy in the treatment of trochanteric bursitis]. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2002;18(7):1-4.</ref>(arthroscopic)
* [[Iliotibial Tract|Iliotibial tract]] (ITT) release<ref name=":6">Mitchell JJ, Chahla J, Vap AR, Menge TJ, Soares E, Frank JM, et al. [https://www.sciencedirect.com/science/article/pii/S2212628716300755 Endoscopic trochanteric bursectomy and iliotibial band release for persistent trochanteric bursitis.] Arthroscopy Techniques. 2016;5(5):e1185-9.</ref>
* ITT bursectomy<ref name=":6" />


8. Cohen S.P., Narvaez J.C., Lebovits A.H., Stojanovic M.P. Corticosteroid injections for trochanteric bursitis: is fluoroscopy necessary? A pilot study. British Journal of Anaesthesia volume 94 , No 1: 100–6, 2005<br>'''Level of Evidence: 3 (C)'''<br>
For gluteal tendon tears, a reconstruction/repair<ref name=":4">Ebert JR, Bucher TA, Mullan CJ, Janes GC. [https://journals.sagepub.com/doi/pdf/10.5301/hipint.5000525 Clinical and functional outcomes after augmented hip abductor tendon repair.] Hip International. 2018 Jan;28(1):74-83.</ref> <ref>Ebert JR, Brogan K, Janes GC. [https://www.researchgate.net/publication/338755889_A_Prospective_2-Year_Clinical_Evaluation_of_Augmented_Hip_Abductor_Tendon_Repair A prospective 2-year clinical evaluation of augmented hip abductor tendon repair.] Orthopaedic Journal of Sports Medicine. 2020 Jan 22;8(1):2325967119897881.</ref>is done. Please see [https://journals.sagepub.com/doi/pdf/10.5301/hipint.5000525 this reference]<ref name=":4" /> for the rehabilitation protocol after abductor tendon repair.


9. Woodley S.J., Nicholson H.D., Livingstone V., Doyle T.C., Meikle G.R., Macintosh J.E., Mercer S.R. Lateral Hip Pain: Findings From Magnetic Resonance Imaging and Clinical Examination. Journal of orthopaedic &amp; sports physical therapy, Vol 38, No. 6, June 2008, pp 313 - 328
== References ==
<references />


10. Paluska S.A., An overview of Hip Injuries in Running. Sports Med 2005; 35, pp 991 – 1014
<br>


11. Ombregt L., Bisschop P., ter Veer H.J., Van de Velde T., A System of Orthopaedic Medicine. 1999.<br>[[Category:Vrije_Universiteit_Brussel_Project|Template:VUB]]
[[Category:Vrije_Universiteit_Brussel_Project]]
[[Category:Primary Contact]]
[[Category:Sports Medicine]]
[[Category:Sports Injuries]]
[[Category:Bursitis]]

Latest revision as of 14:09, 20 January 2024

Original Editors - Emy Van Rode as part of the Vrije Universiteit Brussel's Evidence-based Practice project

Top Contributors - Mudra Shah, Emy Van Rode, Gertjan Van Gijsegem, Lionel Geernaert, Lena Vanderaa, Wendy Snyders, Admin, Kim Jackson, Andrea Nees, Rachael Lowe, Uchechukwu Chukwuemeka, Vidya Acharya, Wanda van Niekerk, WikiSysop and Claire Knott

Definition/Description[edit | edit source]

Trochanteric bursitis was first described in 1923 [1][2]and was used to describe lateral hip pain[2][3] thought to be caused by inflammation of the trochanteric bursa.

The continued use of trochanteric bursitis for lateral hip pain is however unsuitable as bursitis implies inflammation yet three of the four cardinal inflammatory signs, namely rubor, tumour and calor[1][2] [4]are rarely present[1][2].  Studies have revealed that trochanteric bursitis is rarely present in isolation [3][5] and that there is a low prevalence of trochanteric bursa inflammation[3][6] in patients with lateral hip pain. More recently it has become clear that gluteal tendon pathology (gluteal tendinopathy or gluteal tendon tears[1][2][3][7][8]or external coxa saltans [9][4] is more likely the primary cause of the lateral hip pain and that associated trochanteric bursitis can be present[1][2][3][7][8].  The gluteal tendon pathology or external coxa saltans with the possible associated trochanteric bursitis is now referred to as greater trochanteric pain syndrome (GTPS)[2][6][7][8]. If there is GTPS and an associated bursitis, the bursitis can occur in the subgluteus maximus (trochanteric bursa), subgluteus medius or subgluteus minimus bursa but it most commonly occurs in the trochanteric bursa[8].

In the rarer cases of isolated trochanteric bursitis, the causes could include:

If inflammatory signs such as redness, swelling and warmth are present, septic arthritis should be suspected[8][10].  Sometimes septic bursitis can be present without these inflammatory signs and then aspiration is needed to confirm the diagnosis[10]. It can be acute, sub-acute or chronic[10].

  • Other causes of  trochanteric bursitis

Certain auto-immune diseases such as rheumatoid arthritis (RA) can lead to trochanteric bursitis[11] as well as crystal arthropathies such as gout[8]. Direct trauma could potentially also lead to isolated trochanteric bursitis. Isolated trochanteric bursitis due to repetitive rubbing/friction is possible[9] but is very rare[3].

Clinically Relevant Anatomy[edit | edit source]

Trochanteric Bursitis.jpg

A bursa is a sac that usually contains a small amount of fluid and functions as a friction-reducing structure between two anatomical structures, e.g. bone and tendon[8][12]. Bursitis is characterised by soft-tissue swelling, localised pain, synovial thickening and increased fluid in the bursa[12].

The trochanteric bursa covers the posterior facet and lies deep into the gluteus maximus muscle. It also lies over the trochanter attachments of gluteus medius, gluteus minimus and vastus lateralis[8]. The sub gluteus medius bursa is situated at the lateral and superolateral facets deep to the gluteus medius tendon insertion while the sub gluteus minimus bursa is located between the anterior facet and gluteus minimus tendon[8].

Epidemiology /Etiology[edit | edit source]

When there is GTPS with associated  trochanteric bursitis, the following are possible causes/contributing factors:

GTPS is more common in women in their 4th to 6th decades of life[1][7]. A recent study found that only 2% of women had isolated trochanteric bursitis, while 25% had hip abductor tendon pathology with an associated trochanteric bursitis[3].

Septic bursitis occurs when bacteria is introduced into the bursa[14] and can occur due to:

  • Tuberculosis infection (less than 2% of musculoskeletal tuberculosis presents as septic trochanteric bursitis)[4][8][16]
  • Direct puncture of the skin[10]
  • Micro-trauma[10]
  • Cellulitis of the skin that is adjacent to the bursa[10]

Most cases of acute septic bursitis involve Staphylococcus aureus, followed by Streptococcus[10] . Atypical mycobacteria or fungi are associated with chronic septic bursitis[10]. Septic bursitis, in general, is more common in men around the age of 50 years[10]. People who are more susceptible to septic arthritis, in general, include those with inflammatory arthritis (e.g. RA) and those with crystal arthropathies like gout (19).

Characteristics/Clinical Presentation[edit | edit source]

  • Lateral hip pain[2][8][17]
  • Pain to the lateral thigh and knee[2][8][17]
  • Local tenderness over the greater trochanter[2][8][17]
  • Pain with side-lying on the affected side[2][8][17] and sometimes when lying on the unaffected side too due to hip adduction on the affected side[17]
  • Pain with weight-bearing activities[2][8][17]
  • Pain with sitting crossed-legged[17]
  • Pain with prolonged sitting[2][8]

Diagnostic Procedures[edit | edit source]

There is no one specific test to confirm GTPS. Please see the GTPS page for a complete list of the tests that can be used. Concerning imaging, ultrasound can be used but is only indicated if conservative management has failed[8][17]; if the diagnosis is unclear[8][17] or if the primary pathology is thought to be a gluteal tear[8]. MRI can be used for differential diagnosis[1][17].

In septic arthritis, antibiotics should only be started after blood cultures and inflammatory marker investigations have been done and should include white blood count, C-reactive protein and erythrocyte sedimentation[10]. Currently, the gold standard for diagnosis is aspiration and analysis of the bursal fluid[10]. Uric acid and rheumatoid factor should be ordered if one of these is suspected[10]. Imaging does not help diagnose septic arthritis and should only be conducted if other pathology, such as septic arthritis, is suspected[10].

Differential Diagnosis[edit | edit source]

Multiple structures can present as lateral hip pain. In the absence of inflammatory signs, differential diagnosis can include:

If inflammatory signs are present:

Outcome Measures[edit | edit source]

• VISA-G - GTPS-specific outcome measure[18]

Physiotherapy Management[edit | edit source]

If trochanteric bursitis is associated with GTPS, the primary problem will need to be addressed. Please see the Physiopedia pages GTPS, gluteal tendinopathy and coxa saltans on how to manage the primary problems of the associated trochanteric bursitis. For the management of specifically the associated bursitis, please see the medical and surgical management below. The videos below simplifies Trochantric bursitis and it's physiotherapy management

[19]
[20]

Medical Management[edit | edit source]

Corticosteroid injections can be used to manage the associated bursitis in GTPS but they only provide short-term relief[6]. Platelet-rich plasma (PRP) has also been found to be a feasible option[21][22], but it is unknown whether corticosteroid injections or PRP are more effective.

Non-steroidal anti-inflammatory drugs (NSAIDs) may provide analgesia in the acute phase of GTPS or primary bursitis. Still, if the GTPS is chronic, NSAIDs are not advised as they may have a detrimental effect on tendon healing[8].

Septic bursitis is managed with antibiotics and if pain management is needed, NSAIDs can be used[10]. If the NSAIDs are insufficient, corticosteroid injection can be used[10]. TB trochanteric bursitis is also managed with antibiotics but treatment continues for much longer, usually 6-18 months[23].

Surgical Management[edit | edit source]

Indications for surgery for septic arthritis include[10] significant swelling, severe cases that aren’t responding to antibiotics alone or chronic or recurrent cases. Operative interventions include:

  • Suction irrigation[10]
  • Needle aspiration in conjunction with systemic antibiotics[10]
  • If aspiration fails, incision and drainage[10]
  • Bursectomy[10][16][23]

In GTPS, surgical intervention is only indicated if conservative management has failed[7] or if there is a significant tendon tear[17]. Surgical options for GTPS, without a tendon tear, that are safe and effective include:

For gluteal tendon tears, a reconstruction/repair[27] [28]is done. Please see this reference[27] for the rehabilitation protocol after abductor tendon repair.

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Hilligsøe M, Rathleff MS, Olesen JL. Ultrasound definitions and findings in greater trochanteric pain syndrome: a systematic review. Ultrasound in Medicine & Biology. 2020 Jul 1;46(7):1584-98.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 Board TN, Hughes SJ, Freemont AJ. Trochanteric bursitis: the last great misnomer. Hip international. 2014 Nov;24(6):610-5.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Lange J, Tvedesøe C, Lund B, Bohn MB. Low prevalence of trochanteric bursitis in patients with refractory lateral hip pain. Danish medical journal. 2022 Jun 15;69(7):A09210714.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Reid D. The management of greater trochanteric pain syndrome: a systematic literature review. Journal of Orthopaedics. 2016 Mar 1;13(1):15-28.
  5. ↑ Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. American Journal of Roentgenology. 2013 Nov;201(5):1083-6.
  6. ↑ 6.0 6.1 6.2 Koulischer S, Callewier A, Zorman D. Management of greater trochanteric pain syndrome: a systematic review. Acta Orthop Belg. 2017 Jun 1;83(2):205-14.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 Speers CJ, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. British Journal of General Practice. 2017 Oct 1;67(663):479-80.
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 Lin CY, Fredericson M. Greater trochanteric pain syndrome: an update on diagnosis and management. Current Physical Medicine and Rehabilitation Reports. 2015 Mar;3(1):60-6.
  9. ↑ 9.0 9.1 9.2 9.3 Khoury AN, Brooke K, Helal A, Bishop B, Erickson L, Palmer IJ, et al. Proximal iliotibial band thickness as a cause for recalcitrant greater trochanteric pain syndrome. Journal of Hip Preservation Surgery. 2018 Aug;5(3):296-300.
  10. ↑ 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 Truong J, Mabrouk A, Ashurst JV. Septic Bursitis. InStatPearls [Internet] 2021 Sep 14. StatPearls Publishing.
  11. ↑ Suh JY, Park SY, Koh SH, Lee IJ, Lee K. Unusual, but important, peri-and extra-articular manifestations of rheumatoid arthritis: a pictorial essay. Ultrasonography. 2021 Oct;40(4):602.
  12. ↑ 12.0 12.1 Ivanoski S, Nikodinovska VV. Sonographic assessment of the anatomy and common pathologies of clinically important bursae. Journal of Ultrasonography. 2019 Jan 1;19(78):212-21.
  13. ↑ 13.0 13.1 13.2 Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine. 2015 Aug;45(8):1107-19.
  14. ↑ 14.0 14.1 Pascual-Garrido C, Schwabe MT, Chahla J, Haneda M. Surgical treatment of gluteus medius tears augmented with allograft human dermis. Arthroscopy techniques. 2019 Nov 1;8(11):e1379-87.
  15. ↑ Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2001 Sep;44(9):2138-45.
  16. ↑ 16.0 16.1 Vlaic J, Pavic I, Batos AT, Zmak L, Kruslin B. Neglected tuberculous trochanteric bursitis in an adolescent girl: A case report and literature review. Joint diseases and related surgery. 2021 Aug;32(2):536.
  17. ↑ 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. journal of orthopaedic & sports physical therapy. 2015 Nov;45(11):910-22.
  18. ↑ Fearon AM, Ganderton C, Scarvell JM, Smith PN, Neeman T, Nash C, et al. Development and validation of a VISA tendinopathy questionnaire for greater trochanteric pain syndrome, the VISA-G. Manual therapy. 2015 Dec 1;20(6):805-13.
  19. ↑ Zero To Finals. Understanding Trochanteric Bursitis. Available from: http://www.youtube.com/watch?v=Ue9EL8C4R5Y [last accessed 20/01/2024]
  20. ↑ HT Physio - Over-Fities- Specialist Physio. 5 Best Exercises to FIX Hip Bursitis (Pain on Outside of Hip). Available from: http://www.youtube.com/watch?v=lRTEnTT4vlY [last accessed 20/01/2024]
  21. ↑ Jacobson JA, Yablon CM, Henning PT, Kazmers IS, Urquhart A, Hallstrom B, et al. Greater trochanteric pain syndrome: percutaneous tendon fenestration versus platelet‐rich plasma injection for the treatment of gluteal Tendinosis. Journal of Ultrasound in Medicine, 2016; 35(11):2413-2420.
  22. ↑ Ali M, Oderuth E, Atchia I, Malviya A. The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review. Journal of Hip Preservation Surgery. 2018 Aug;5(3):209-19.
  23. ↑ 23.0 23.1 Ramos-Pascua LR, Carro-Fernández JA, Santos-Sánchez JA, Ramos PC, Díez-Romero LJ, Izquierdo-García FM. Bursectomy, curettage, and chemotherapy in tuberculous trochanteric bursitis. Clinics in Orthopedic Surgery. 2016 Mar 1;8(1):106-9.
  24. ↑ Wiese M, Rubenthaler F, Willburger RE, Fennes S, Haaker R. Early results of endoscopic trochanter bursectomy. International orthopaedics. 2004 Aug;28(4):218-21.
  25. ↑ Fox JL. The role of arthroscopic bursectomy in the treatment of trochanteric bursitis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2002;18(7):1-4.
  26. ↑ 26.0 26.1 Mitchell JJ, Chahla J, Vap AR, Menge TJ, Soares E, Frank JM, et al. Endoscopic trochanteric bursectomy and iliotibial band release for persistent trochanteric bursitis. Arthroscopy Techniques. 2016;5(5):e1185-9.
  27. ↑ 27.0 27.1 Ebert JR, Bucher TA, Mullan CJ, Janes GC. Clinical and functional outcomes after augmented hip abductor tendon repair. Hip International. 2018 Jan;28(1):74-83.
  28. ↑ Ebert JR, Brogan K, Janes GC. A prospective 2-year clinical evaluation of augmented hip abductor tendon repair. Orthopaedic Journal of Sports Medicine. 2020 Jan 22;8(1):2325967119897881.


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