Most Suggestive Symptom of Greater Trochanteric Bursitis
The most suggestive symptom of greater trochanteric bursitis is point tenderness over the posterolateral aspect of the greater trochanter, combined with chronic, intermittent aching pain over the lateral hip that may radiate down the lateral thigh to the knee. 1, 2
Key Clinical Features
Primary Diagnostic Symptoms
- Lateral hip pain that is chronic and intermittent in nature, representing the hallmark presentation 1
- Point tenderness on palpation of the posterolateral greater trochanter area is the most specific physical examination finding 2
- Pain radiation along the lateral aspect of the thigh to the knee, and occasionally below the knee or into the buttock 2
Associated Symptoms That Support the Diagnosis
- Paraesthesiae in the legs may occur, which can mimic nerve root compression syndromes 3
- Pain with repetitive loading of the lateral hip structures, particularly activities that stress this region 4
- Morning stiffness lasting more than 30 minutes in patients younger than 45 years should raise concern for underlying axial spondyloarthropathy rather than simple trochanteric bursitis 5
Important Clinical Pitfalls
Mimicking Conditions
The American College of Radiology emphasizes that differentiation between true bursitis and gluteus medius/minimus tendinopathy is difficult, as these conditions frequently coexist 4, 6. This overlap means that what appears clinically as trochanteric bursitis may actually represent greater trochanteric pain syndrome, which encompasses bursitis, abductor tendinopathy, and external coxa saltans 7.
Red Flag Presentations
- In patients with hip prostheses, extracapsular disease from adverse reactions to metal debris (ARMD) can be misinterpreted as trochanteric bursitis 5
- In patients under 45 years with morning stiffness exceeding 30 minutes, obtain MRI of sacroiliac joints and refer to rheumatology to rule out axial spondyloarthropathy 5
- Patients with chronic low back pain and sciatica should be routinely checked for greater trochanteric bursitis pain syndrome, as it frequently coexists and may be the primary pain generator 3
Diagnostic Approach After Clinical Suspicion
Initial Imaging
- Radiographs should be obtained first to rule out other causes of hip pain such as arthritis or bone tumors, as recommended by the American College of Radiology 5, 6