What physical exam findings are expected in a patient with suspected trochanteric bursitis?

Physical Exam Findings in Trochanteric Bursitis

The hallmark physical exam finding is point tenderness to palpation directly over the greater trochanter, typically assessed with the patient in the side-lying position. 1

Primary Physical Exam Findings

Location of Tenderness

• Reproducible tenderness over the greater trochanter is the defining clinical feature, often accompanied by pain in the lateral hip, buttock, or lateral thigh region 1
• The tenderness is characteristically localized to the lateral aspect of the hip, directly over the bony prominence of the greater trochanter 2
• Pain may radiate down the lateral thigh but remains centered at the trochanteric region 2

Examination Technique

• The patient should be positioned in the side-lying position (affected side up) to optimally palpate the greater trochanter and elicit tenderness 1
• Direct palpation over the greater trochanter reproduces the patient's characteristic pain 3

Associated Clinical Features

Pain Characteristics

• Patients typically report chronic, intermittent aching pain over the lateral hip that may be sharp with certain movements 2, 4
• Pain is often worse with activities involving repetitive loading of lateral hip structures 5
• Lying on the affected side frequently exacerbates symptoms 2

Critical Diagnostic Considerations

Differential Diagnosis on Exam

• It is essential to clinically exclude lumbar spine pathology and hip joint pathology before attributing symptoms to trochanteric bursitis, as these can refer pain to the lateral hip region 3
• The combination of lateral location of pain plus characteristic trochanteric tenderness is usually sufficient to reach a clinical diagnosis once other pathology is excluded 3

Important Caveats

• The term "trochanteric bursitis" is somewhat of a misnomer, as evidence suggests that in the majority of cases, symptoms actually result from pathology of the gluteus medius or minimus tendons rather than true bursal inflammation 3
• Ultrasound studies demonstrate that only 20.2% of patients with greater trochanteric pain syndrome actually have bursitis, while 49.9% have gluteal tendinosis and 28.5% have iliotibial band thickening 6
• Differentiation between true bursitis and gluteus medius/minimus tendinopathy can be difficult on clinical exam alone, as these conditions frequently coexist 7, 5

When Physical Exam Alone Is Insufficient

• If the clinical features (lateral pain plus trochanteric tenderness) are present after excluding spine and hip joint pathology, imaging is not always necessary for diagnosis 8
• However, when symptoms persist or diagnosis is uncertain, radiographs should be obtained first to rule out other causes, followed by ultrasound as the preferred imaging modality 7, 9