Hip Bursitis Symptoms
Hip bursitis (trochanteric bursitis) presents with chronic, intermittent aching pain over the lateral aspect of the hip that is the hallmark symptom, often accompanied by point tenderness over the greater trochanter. 1
Primary Clinical Presentation
Pain location and character: Patients experience aching pain localized to the lateral hip region over the greater trochanter, which is chronic and intermittent in nature 1
Pain aggravating factors: Symptoms worsen with direct pressure (such as lying on the affected side), climbing stairs, prolonged standing, or increased physical activity 1
Pain relief patterns: Discomfort typically improves when walking barefoot or avoiding pressure on the affected area 2
Functional limitations: Patients often report difficulty with activities of daily living due to pain and reduced hip mobility 1
Physical Examination Findings
Point tenderness: Exquisite tenderness to palpation directly over the greater trochanter is the most consistent physical finding 1
Swelling: A palpable prominence or swelling may be appreciated medially and laterally to the greater trochanter 2
Associated findings: Warmth over the affected area may be present in acute cases 2
Diagnostic Imaging Characteristics
Ultrasound findings: US can detect fluid collections in the trochanteric bursa, bursal thickening, and associated gluteus medius tendinosis (which frequently coexists and may be difficult to differentiate from isolated bursitis) 2
MRI findings: MRI without IV contrast can assess the trochanteric bursa, surrounding soft tissues including gluteus minimus and medius muscles, and abductor tendons 2
Radiographic findings: Plain radiographs may show calcifications around the greater trochanter in cases of calcific trochanteric bursitis, though standard radiographs are often normal 3
Important Clinical Considerations
Age distribution: The incidence peaks between the fourth and sixth decades of life (ages 30-60), though cases occur across all age groups 1
Gender predilection: This condition is most common in women aged 20-30 years, particularly when associated with Haglund's deformity, though it affects both sexes 2
Multiple bursa involvement: Trochanteric area pain often involves inflammation of not just one but all four peri-trochanteric bursae, which is clinically more extensive than the term "trochanteric bursitis" suggests 4
Differential Diagnosis Pitfalls
Coexisting pathology: Gluteus medius tendinosis or tears frequently coexist with trochanteric bursitis and may be the primary pain generator rather than isolated bursal inflammation 2
Post-surgical cases: After total hip arthroplasty, extracapsular disease associated with adverse reaction to metal debris (ARMD) can be misinterpreted as trochanteric bursitis 2
Referred pain: Pain described as "hip pain" by patients may actually originate from the low back, pelvis, or knee, requiring careful evaluation to exclude the hip as the source 2
Diagnostic Confirmation
Initial imaging: Plain radiographs of the pelvis and hip should be obtained first to exclude other pathology 2, 5
Advanced imaging: When radiographs are negative or equivocal and extra-articular soft tissue abnormality such as bursitis is suspected, MRI hip without IV contrast or ultrasound are appropriate next steps 2
Diagnostic injection: Image-guided injection of the bursa with lidocaine alone (as a diagnostic test) or in combination with corticosteroid can confirm the diagnosis and provide therapeutic benefit 2