Trochanteric Bursitis In Singapore

Hip pain affecting your daily activities can be frustrating and limiting. If you’re experiencing pain on the outer side of your hip-especially when lying on that side or climbing stairs-you may have trochanteric bursitis. With proper diagnosis and treatment, most patients experience significant improvement in their symptoms.

Dr Zackary Chua

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (Aus)MMed (SG)MRCS (Glasgow)FRCSEd (Orth)

Causes & Risks Symptoms When to see a Doctor Diagnosis Treatment Complications Prevention FAQ Conclusion

What is Trochanteric Bursitis?

Trochanteric bursitis is an inflammation of the bursa, a small fluid-filled sac that cushions the greater trochanter (the bony prominence on the outer hip). The bursa helps reduce friction between bone and soft tissues during movement. When it becomes irritated or inflamed, it causes pain and tenderness in the hip area. This condition is one of the most common causes of hip pain, particularly in middle-aged and older adults, affecting women more frequently than men.

Causes

Certain factors increase the likelihood of developing trochanteric bursitis:

Repetitive stress on the hip from activities like running, cycling, or prolonged standing
Direct trauma to the hip from falls or impacts
Hip bone spurs or calcium deposits that rub against the bursa
Poor posture or altered gait patterns
Previous hip surgery or hip replacement complications
Bacterial infection of the bursa (septic bursitis)

Risk Factors

Several factors increase your likelihood of developing trochanteric bursitis:

Age, more common in people over 40
Gender, with women affected 2-3 times more than men
Leg length difference causing uneven weight distribution
Spine conditions, such as scoliosis or lumbar spine disease
Inflammatory conditions like rheumatoid arthritis
Obesity, placing extra stress on hip joints
Occupations or activities requiring prolonged standing or repetitive hip movements
Sports participation, especially running and cycling

Signs & Symptoms

Mild Symptoms

Aching pain on the outer hip that worsens with activity
Mild tenderness when pressing on the hip
Slight discomfort when lying on the affected side
Morning stiffness that improves with movement
Occasional sharp pain with certain movements

Moderate Symptoms

Persistent pain extending down the outer thigh
Difficulty sleeping due to hip discomfort
Pain when climbing stairs or getting out of a car
Noticeable limping or altered walking pattern
Swelling or warmth around the hip area

Severe Symptoms

Intense, constant pain even at rest
Inability to lie on the affected side
Significant mobility limitations
Pain radiating to the lower back or knee
Marked swelling and redness (may indicate infection)

Symptoms typically develop gradually over weeks to months, though pain may appear suddenly after direct trauma. The pain often worsens at night and may interfere with sleep quality.

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When to See a Doctor

Consult an orthopaedic specialist if you experience persistent hip pain lasting more than two weeks despite rest and home care. Immediate medical attention is necessary if you have severe pain accompanied by fever, sudden swelling, or redness around the hip, as these may indicate an infection. Other warning signs include hip pain following a fall or injury, pain that significantly limits your daily activities, or symptoms that progressively worsen despite conservative measures.

During your first consultation, our orthopaedic surgeon will conduct a thorough examination, including specific tests to reproduce your symptoms and rule out other hip conditions. They will also review your medical history, activity levels, and any previous hip problems to develop an accurate diagnosis and treatment plan.

Diagnosis & Testing Methods

Diagnosing trochanteric bursitis typically begins with a comprehensive physical examination. Our orthopaedic surgeon will palpate the outer hip to locate areas of maximum tenderness and may perform tests such as the FABER test (flexion, abduction, and external rotation) or ask you to perform movements that typically trigger your pain.

While the condition is often diagnosed clinically, imaging may be used to confirm the diagnosis or rule out other conditions. X-rays can reveal bone spurs, arthritis, or other bony abnormalities. Ultrasound allows real-time visualisation of the inflamed bursa and surrounding soft tissues, while MRI provides detailed images of both bone and soft tissue structures, helping to identify bursal thickening, fluid accumulation, or other hip pathologies.

Blood tests may be ordered if infection is suspected or to evaluate underlying inflammatory conditions. The entire diagnostic process typically takes one to two visits, with most imaging results available within a few days.

Treatment Options Overview

Conservative Management

Physiotherapy focuses on stretching tight hip muscles, particularly the iliotibial band and hip flexors, while strengthening the hip abductors and core muscles. It also addresses any biomechanical issues contributing to the condition.

Activity Modification

Temporary modification of activities that aggravate symptoms is essential for recovery. This may include avoiding prolonged standing, reducing high-impact exercise, or practising proper ergonomics at work. Low-impact exercises like swimming or cycling can maintain fitness while allowing the bursa to heal.

Oral Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can reduce pain and inflammation. Our orthopaedic surgeon may prescribe these for short-term use, typically 2-4 weeks, while monitoring for potential side effects.

Injection Therapies

Corticosteroid injections directly into the bursa can provide significant pain relief for patients who don’t respond to conservative measures. These injections, often combined with local anaesthetic, can reduce inflammation for several months. Most patients experience improvement within 48-72 hours of injection.

Platelet-Rich Plasma (PRP) Therapy

PRP injections use concentrated platelets from your own blood to promote healing and reduce inflammation. This regenerative treatment option may be considered for chronic cases or patients who prefer to avoid corticosteroid injections.

Extracorporeal Shockwave Therapy

This non-invasive treatment uses acoustic waves to stimulate healing and reduce pain. Typically performed over 3-5 sessions, shockwave therapy can be effective for chronic trochanteric bursitis that hasn’t responded to other conservative treatments.

Surgical Intervention

Surgery is seldom required for trochanteric bursitis and is typically considered only after 6–12 months of unsuccessful conservative treatment. Arthroscopic bursectomy removes the inflamed bursa through small, minimally invasive incisions. In certain cases, additional procedures such as iliotibial band release or removal of bone spurs may be performed to address underlying causes of irritation.

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Complications if Left Untreated

If trochanteric bursitis is not properly managed, it can lead to ongoing hip pain and reduced quality of life. Chronic inflammation may cause permanent thickening of the bursa, making it more susceptible to irritation. Pain-related compensatory movements can strain other areas, including the lower back, opposite hip, and knees.

Long-term inflammation may result in calcium deposits forming within the bursa, causing chronic irritation. Some patients develop chronic pain syndrome, where the nervous system becomes hypersensitive to pain signals. Avoiding physical activity due to pain can lead to muscle weakness, weight gain, and overall deconditioning, creating a cycle that makes recovery more challenging.

Prevention

Preventing trochanteric bursitis focuses on maintaining hip health and addressing modifiable risk factors. Regular stretching of the hip flexors, iliotibial band, and gluteal muscles helps improve flexibility and reduce stress on the bursa. a. Strengthening exercises for the hip abductors and core muscles provide better support and stability for the hip joint.

Maintaining a healthy weight reduces stress on all weight-bearing joints, including the hips. If you have a leg length discrepancy, using appropriate shoe inserts can help distribute weight evenly. For runners and athletes, gradual training progression and proper warm-up routines are essential. Using proper techniques during exercise and avoiding sudden increases in activity intensity or duration can prevent overuse injuries.

Trochanteric Bursitis

Frequently Asked Questions

How long does trochanteric bursitis typically take to heal?

Recovery time varies depending on severity and treatment approach. With appropriate conservative treatment, most patients experience significant improvement within 6-8 weeks. Mild cases may resolve in 2-4 weeks with rest and anti-inflammatory medications. Chronic cases or those requiring injections may take 3-6 months for complete resolution. Consistency with physiotherapy exercises and activity modification greatly influences recovery speed.

Can trochanteric bursitis come back after treatment?

Yes, recurrence is possible, particularly if contributing factors aren’t managed. Completing a physiotherapy programme, maintaining regular stretching and strengthening exercises, addressing biomechanical issues, and keeping a healthy weight all help reduce the risk. Occasional flare-ups may still occur but usually respond well to early intervention.

Is trochanteric bursitis the same as hip arthritis?

No, these are different conditions affecting different structures. Trochanteric bursitis involves inflammation of the bursa on the outer hip, while hip arthritis affects the joint itself. Bursitis pain is typically on the outer hip and worsens with pressure, while arthritis pain is usually felt in the groin and worsens with weight-bearing. Both conditions can coexist, and proper diagnosis through examination and imaging helps distinguish between them.

What activities should I avoid with trochanteric bursitis?

During the acute phase, avoid activities that directly pressure or stress the affected hip. This includes lying on the affected side, prolonged standing, running on hard surfaces, and climbing stairs repeatedly. High-impact activities and exercises requiring repetitive hip movements should be temporarily modified. As symptoms improve, activities can be gradually reintroduced under guidance from our orthopaedic surgeon.

Are steroid injections safe for treating trochanteric bursitis?

Corticosteroid injections are generally safe. Side effects are uncommon but may include temporary pain flare, skin discolouration, or small changes in fat tissue at the injection site. The number of injections is usually limited to a few per year to minimise potential risks. Your healthcare provider will discuss the benefits and risks based on your condition and medical history.

Can I exercise with trochanteric bursitis?

Yes, but exercise should be modified to avoid aggravating your condition. Low-impact activities like swimming, water aerobics, and stationary cycling are comfortable and safe for your hip. Targeted stretching and strengthening exercises are important for recovery. Avoid high-impact activities and exercises that cause pain. As symptoms improve, you can gradually return to more demanding activities under professional guidance.

Conclusion

Trochanteric bursitis, though painful and limiting, is a manageable condition with positive outcomes for most patients. Early diagnosis and timely intervention can prevent chronic symptoms and help you return to your normal activities. Treatment options range from conservative measures such as physiotherapy and activity modification to targeted interventions like injections or surgery. The key to effective management is identifying the underlying causes and following a comprehensive, personalised treatment plan suited to your individual needs.

Hip discomfort shouldn’t be ignored.

Consult with a specialist to evaluate your symptoms and develop a treatment plan suited to your lifestyle.

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Dr Zackary Chua (蔡克祥医生)

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (AUS)|MMed (Singapore)|MRCS (Glasgow)|FRCSEd (Orth)

A senior consultant orthopaedic surgeon with dual specialisations in Foot & Ankle Surgery and Paediatric Orthopaedics. Backed by his extensive years of training and experience, Dr Chua brings the necessary knowledge and skills to ensure a smooth recovery journey.

Rooted firmly by two fundamental philosophies: “When one’s feet hurt, one hurts all over” and “Children are not little adults”, Dr Chua’s approach to patient care reflects his compassionate care for adults and children.

Singhealth Quality Excellence Award – Silver (2011)
Service From the Heart Award (2021)
Singapore Health Quality Service Award – Gold (2023)
NUS Medicine Dean’s Award for Teaching Excellence (2023)

His active participation in the medical community extends to mentoring, research supervision, and contributions to key professional forums and symposiums, both locally and internationally.