Bursitis

Overview

•Trochanteric bursitis (greater trochanteric pain syndrome) - most exam-relevant site; typically affects middle-aged to older women

•Lateral hip pain - localised to the greater trochanter, may radiate down the lateral thigh but does NOT extend to the knee or below (unlike radiculopathy)

•Nocturnal pain - classically worse when lying on the affected side

•Point tenderness over the greater trochanter on palpation

•Pain on external rotation of the abducted hip - key examination finding

•Hip range of motion generally preserved (unlike hip OA or fracture)

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Trochanteric bursitis has insidious onset lateral thigh pain + focal tenderness over the greater trochanter + pain on external rotation of abducted hip. Pain does not extend below the knee.

Key differentials

Trochanteric bursitis vs lateral hip/thigh pain differentials
ConditionPain locationKey distinguishing feature
Trochanteric bursitisLateral hip/thighPoint tenderness over greater trochanter; pain on external rotation of abducted hip
ITB syndromeLateral kneePain distal, typically post-running; not over trochanter
Iliopsoas tendonitisAnterior hip/groinWorsened by hip flexion activities
Hip fractureHipHistory of trauma; shortened/externally rotated leg; unable to weight-bear
Avascular necrosisGroin-predominantLimited passive abduction and internal rotation

Condition	Pain location	Key distinguishing feature
Trochanteric bursitis	Lateral hip/thigh	Point tenderness over greater trochanter; pain on external rotation of abducted hip
ITB syndrome	Lateral knee	Pain distal, typically post-running; not over trochanter
Iliopsoas tendonitis	Anterior hip/groin	Worsened by hip flexion activities
Hip fracture	Hip	History of trauma; shortened/externally rotated leg; unable to weight-bear
Avascular necrosis	Groin-predominant	Limited passive abduction and internal rotation