Greater Trochanteric Bursitis

The greater trochanter is the “large bony bump” that projects out of the proximal (near end) of the femur. You can feel where the greater trochanter protrudes by rubbing the area where a cowboy’s holster would rest. The most lateral bony bump felt by your hand over the side of your hip would be the greater trochanter. This bony prominence is the area of insertion of multiple muscles that move the hip joint.

Immediately adjacent to the greater trochanter is a thick flat tendon that passes directly lateral to this bone. This tendon is called the tensor fascia lata (TFL) and connects muscles originating on the pelvis to the outside of the knee. The greater trochanter produces significant pressure on this tendon. The body has ingeniously developed a bursa (a frictionless sack) between these two structures to prevent this friction.

The greater trochanteric bursa is essentially a thin water balloon filled with a very small amount of oil (synovial fluid). The two outside walls of the balloon are frictionless when coated by this synovial fluid. The surfaces of the bursal “balloon” rub against each other, eliminating friction and preventing pressure from developing.

Like any other part of the body, this bursal sack can occasionally cause trouble. The walls of the bursa can thicken, become irregular and the oil inside can become sludge-like. This is all due to inflammation. Trauma, overuse, infection, prior hip surgery and metabolic disorders can all cause this bursitis (inflammation of the bursa). Repetitive motions of the hip (cycling, running, weight training) can also lead to greater trochanteric bursitis.

If greater trochanteric bursitis is present for a prolonged period of time, calcification of the bursa can occur or the muscle insertions can ossify which can be demonstrated on an X-ray (see images). Most episodes of greater trochanteric bursitis however are not apparent on X-rays.

The symptoms of GTB are lateral hip pain made worse with activity and pain that is increased by lying on the side of the inflamed bursa. The pain can occasionally keep the patient up at night. If progression occurs, the hip can ache without activity or pressure. The bursa will be tender to palpation and rare crepitus (a feeling of unevenness) can occur with hip motion.

Interestingly, disorders of the spine can refer pain to this region, mimicking greater trochanteric bursitis. This is a common referral area for L1-L4 nerve compression and lower lumbar spine disc and facet degeneration. Hip disorders (arthritis and labral tears) can also refer pain to the lateral hip region.

Treatment

Initial treatment is reduction of activities, NSAIDs (Motrin, Aleve) and a walking aid (cane or equivalent) if pain is severe. Physical therapy is used to stretch the tendon and provide palliative care (ultrasound, hot/cold and iontophoresis-medication driven into the bursa through electricity) and electrical stimulation.

If symptoms are severe, a steroid injection can be provided directly into the bursa in the physician’s office. The injection can be curative but generally will give relief measured in months. A repeat injection might be indicated for return of symptoms.

Finally, if nothing seems to give relief, a surgical bursectomy (removal of the bursa) can be performed. This procedure can be performed through an arthroscope. The surgical success rate is high.

(Click to Enlarge) MRI of left greater trochanteric bursitis (arrow) This view is a cut through the beltline. The white area is inflammation.

(Click to Enlarge) Greater trochanteric bursitis. Compare the right side of the picture to the left side. Note the right side lateral hip region is whiter than the left side. White=tendonosis.

(Click to Enlarge) Note the ‘fluffy bone’ just outside the greater trochanter (arrow). This is new bone formation from tendonosis.

Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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Greater Trochanteric Bursitis

Treatment

About the Author: Donald Corenman, MD, DC