Trochanteric Bursitis: Why the Outer Hip Hurts at Night

Trochanteric Bursitis: Why the Outer Hip Hurts at Night

What is trochanteric bursitis? Outer hip pain, trouble lying on your side and pain on stairs; how it differs from other hip problems, managing load in daily life, exercise and other treatments.

Trochanteric bursitis is a common cause of pain on the outer side of the hip, arising when the fluid-filled sac over the bony point of the hip (the greater trochanter) and the surrounding tendons become irritated. Typical complaints are being unable to lie on the painful side, pain that increases on stairs and long walks, and tenderness when pressing on the outer hip. Current understanding is that the pain often comes not only from the bursa but also from strain in the gluteal tendons that move the hip outwards, so load management and well-planned exercise sit at the heart of treatment.

This article explains why it develops, who is affected, the symptoms, how it is told apart from other causes of hip pain, what to watch for in daily life and the treatment options.

What is trochanteric bursitis?

The greater trochanter is the bony bump you can feel at the top of the outer thigh. The tendons of gluteus medius and gluteus minimus, which move the leg outwards and keep the pelvis level when you walk, attach to it. Small fluid sacs, or bursae, reduce friction between these tendons, the bone and the thick band of tissue running over them (the iliotibial band).

When the tendons and bursa are repeatedly overloaded or compressed, irritation and pain develop. This is increasingly called greater trochanteric pain syndrome, because the gluteal tendons are often involved along with the bursa. If a tendon tear is a concern, see our article on gluteus medius tears.

Who gets it?

It can occur at any age but is especially common in women over 40. Factors that raise the risk include:

• Weakness of the muscles that move the hip outwards
• Excess body weight
• A sudden increase in walking, running or stair climbing
• Running or walking for long periods on sloping surfaces
• Habitually standing with your weight on one hip or sitting with legs crossed
• Leg-length difference or other hip or lower back problems
• A fall or direct blow to the outer hip

What are the symptoms?

• Pain over and around the bony point on the outer hip
• Being unable to lie on the painful side, and waking when turning at night
• Sometimes pain when lying on the other side, as the top leg drops down
• Pain on stairs, uphill and during long walks
• Difficulty standing on one leg or putting on shoes and trousers
• Pain getting up from a low chair or car, and when crossing the legs
• Pain that may spread down the outer thigh towards the knee

The pain usually stays above the knee and does not cause marked numbness or tingling, which helps distinguish it from nerve problems coming from the lower back.

Conditions that can feel similar

• Hip osteoarthritis: pain is felt more in the groin, with stiffness and restricted movement.
• Lumbar disc problems and nerve compression: pain starts in the back and spreads down the leg, often below the knee, sometimes with numbness and tingling.
• Hip impingement and labral tears: usually groin pain, catching and pain that worsens with sitting.
• Nerve compression on the outer thigh: burning and numbness over the outer thigh.
• Gluteal tendon tears: marked weakness and the pelvis dropping to the other side when walking.

Our article on telling hip pain apart from a lumbar disc problem covers this in more detail.

How is it diagnosed?

The diagnosis is usually made from your history and examination. The doctor checks for tenderness over the greater trochanter, whether standing on one leg for a while provokes the pain, the strength of the hip muscles and the movement of the hip joint. The lower back and hip joint are always examined too.

• X-ray: to assess associated conditions such as hip osteoarthritis.
• Ultrasound: shows fluid in the bursa and the gluteal tendons, and can guide an injection if needed.
• MRI: for pain that persists despite treatment, a suspected tendon tear or an unclear diagnosis.

How is trochanteric bursitis treated?

Most people are treated without surgery. The cornerstones are reducing compression on the tendons and gradually strengthening the hip muscles.

Managing load in daily life

• Avoid lying on the painful side; when lying on the other side, put a pillow between your knees.
• Do not cross your legs and avoid very low chairs.
• Stand with your weight evenly on both legs rather than leaning into one hip.
• Cut back on stairs, hills and long walks until the pain settles.
• If you are overweight, losing weight can reduce the load on the hip.

Exercise therapy

Strengthening the muscles that move the hip outwards is the most important part of treatment. Programmes usually start with gentle isometric exercises, holding a contraction without movement, and progress as pain allows to bridges, side steps and single-leg balance. Some intense stretches that pull the leg across the body can increase pressure on the tendons, so the programme is ideally planned with a physiotherapist or doctor. Benefits usually appear over weeks, and response varies between individuals.

Simple starting exercises often include the following; stop and ask your doctor if they clearly increase the pain:

1. Wall press: stand with the painful side facing a wall, bend the knee slightly and press the outer hip towards the wall for 20–30 seconds.
2. Bridge: lie on your back with knees bent, lift the hips slowly, hold for a few seconds and lower.
3. Side steps: with feet shoulder-width apart and knees slightly bent, take small steps sideways, building up the time as pain allows.

Supporting treatments

• Painkillers: can give short-term relief; check with your doctor before regular use.
• Corticosteroid injection: may ease significant pain in the short term, but may not be enough on its own, and repeated injections need careful thought because of their effect on tendon tissue. It works better alongside an exercise programme.
• Shockwave therapy: may be an option for long-standing symptoms.
• PRP: may be considered for some people with stubborn gluteal tendon pain; the evidence is still developing.

When is surgery needed?

Surgery is rarely needed. If pain persists after months of consistent exercise and other treatments, or a significant gluteal tendon tear is found, removing the bursa and repairing the tendon may be considered, in suitable cases endoscopically. In Prof. Dr. Gökhan Polat's clinic, the plan takes into account the source of the pain, the condition of the tendons, the overall health of the hip joint and the patient's activity level.

When should you see an orthopedic surgeon?

• Outer hip pain that has not eased after a few weeks of load management
• Pain that wakes you at night and makes side-lying impossible
• A limp, marked hip weakness or being unable to stand on one leg
• Hip pain that began after a fall or blow
• Pain together with catching in the groin, numbness or weakness in the leg

Urgent assessment: redness, warmth and swelling over the hip with fever needs prompt care because of the possibility of infection, and being unable to bear weight after a fall is also an emergency. To learn more about the causes of hip pain and treatment options, visit our hip joint diseases page.

In summary

• Trochanteric bursitis causes outer hip pain and often involves the gluteal tendons as well as the bursa.
• Pain lying on the affected side, on stairs and on long walks, with tenderness over the bony point, is typical.
• Treatment rests on load management and progressive hip strengthening; injections can play a supporting role.
• Surgery is rarely needed; persistent pain, weakness or night pain warrants examination, and response varies from person to person.

This article is for general information only; diagnosis and treatment decisions are made individually after examination and the necessary tests.