Overview
what it is and why it mattersThe greater trochanter is the bony prominence on the outer side of your upper femur. A bursa, a small fluid-filled cushioning sac, lies over it, allowing the iliotibial band and gluteal tendons to glide without friction. When that bursa becomes inflamed (bursitis), every step that loads the outer hip causes pain.
This is the most common cause of pain on the outer side of the hip. It's more common in middle-aged women and in runners. Weak side-hip muscles, a leg-length difference, and a tight iliotibial (IT) band all contribute. Doctors increasingly use the broader term greater trochanteric pain syndrome because partial tearing of the gluteal tendons (the muscles you'd land on if you fell sideways) frequently sits alongside the bursitis or mimics it.
Symptoms
what you may noticeThe hallmark complaint is pain on the outer side of your hip, right over the bony bump you can feel when you press your hand against your upper thigh (the greater trochanter). Lying on that side at night is often the worst trigger: it wakes you up or keeps you from falling asleep. Climbing stairs, getting out of a car, and long walks all flare the pain.
The ache can radiate down the outer thigh toward the knee, but it rarely travels below the knee. If it does, the source is more likely your spine than the bursa. You may also notice stiffness in the hip for the first several steps after sitting. The condition is more common in middle-aged women, runners, and anyone with a wider pelvis or a leg-length difference.
Diagnosis
exam first, imaging secondThe hallmark is sharp point tenderness right over the bony bump on the outer hip: pressing on it reproduces the pain. Symptoms typically get worse lying on that side at night, climbing stairs, and after walking. X-rays are usually normal but rule out other bone problems. Ultrasound or MRI can confirm the bursitis and pick up any associated gluteal tendon tear.
How We Treat It
what we try first, in orderGreater trochanteric bursitis settles down for most people without surgery. The treatments below are listed in the order we usually introduce them, each one added on top of the ones before, not instead of. The first three are the foundation; the injections come into play if the pain is still limiting you.
1
Activity modification & load management
Cutting back on high-impact activities and avoiding positions that bring your knees together (crossing legs, sleeping with the painful hip down on a soft mattress) reduces irritation.
2
Physical therapy
Strengthening the side-hip muscles (especially the gluteus medius, the main one that holds your pelvis level when you stand on one leg) is the most effective long-term treatment.
Corticosteroid injection
An corticosteroid injection into the bursa, guided in real time by ultrasound, gives short-term pain relief and a window to do the physical therapy that provides the lasting benefit.
PRP injection
A PRP (platelet-rich plasma) injection, concentrated growth factors taken from your own blood, placed into the bursa or into an associated tendon tear. Considered only after rest, activity changes, physical therapy, NSAIDs, and a corticosteroid injection have been tried, when cortisone has given only short-term relief. The evidence for it in this condition is limited. It is not covered by insurance (self-pay).
Surgical Options
if non-operative care isn't enoughSurgery is rarely needed for bursitis itself. When a confirmed gluteal tendon tear (partial or full) hasn't responded to non-operative care, surgical repair may be considered.
Frequently Asked
questions we hear in clinicWhy does it hurt so much more at night?
Lying on the affected side presses directly on the inflamed bursa over the bony bump on the outer hip, so that position is often the worst trigger. It can wake you up or keep you from falling asleep. Avoiding sleeping with the painful hip down on a soft mattress is part of the early treatment.
Do I need an MRI to diagnose it?
Usually not. The hallmark is sharp point tenderness right over the bony bump on the outer hip, and pressing on it reproduces the pain. X-rays are usually normal but help rule out other bone problems. Ultrasound or MRI is used when we need to confirm the bursitis or pick up an associated gluteal tendon tear.
The pain runs down my outer thigh. Is that normal?
Yes. The ache can radiate down the outer thigh toward the knee. It rarely travels below the knee, and if it does, the source is more likely your spine than the bursa.
What is the most effective long-term treatment?
Strengthening the side-hip muscles, especially the gluteus medius (the main muscle that holds your pelvis level when you stand on one leg), is the most effective long-term treatment. It is done through physical therapy and works best alongside cutting back on high-impact activities.
When is a cortisone injection used?
A corticosteroid injection into the bursa, guided in real time by ultrasound, gives rapid, significant pain relief and creates a window to do the physical therapy that keeps the pain from coming back. It is used when the first-line measures alone have not settled things down.
Will I need surgery?
Almost certainly not. Surgery is rarely needed for bursitis itself. It is considered only when a confirmed gluteal tendon tear, partial or full, has not responded to non-operative care.
Providers Who Treat Greater Trochanteric Bursitis
sports-medicine team
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: