Trochanteric Bursitis: What Causes It and Why Does Your Outer Hip Hurt?
Trochanteric bursitis is pain and inflammation at the bony point on the outside of your hip, called the greater trochanter. It is often part of a wider problem now called greater trochanteric pain syndrome (GTPS), which can include gluteal tendinopathy. The pain typically gets worse when you walk, climb stairs or lie on the affected side.
Key points
- GTPS is one of the most common causes of outer hip pain in adults.
- It often involves the tendons and muscles around the hip, not just the bursa.
- Pelvic tilt, a difference in leg length or a change in the way you walk can overload the outer hip.
- Standing, weight-bearing imaging can show alignment factors that lying-down scans miss.
- ScanAlign provides diagnostic imaging only. Treatment is guided by your clinician.
You may have been told you have trochanteric bursitis. Or you may have searched for "outer hip pain" after weeks of aching that will not settle. The term is well known, but the picture is usually bigger than a single inflamed bursa. Clinicians now accept that most outer hip pain involves changes in the gluteal tendons and the structures around them. The umbrella term for this is greater trochanteric pain syndrome, or GTPS.
Knowing the difference matters, because the right imaging can change the direction of your care. Just as important, the cause of your outer hip pain may not even start at the hip itself.
What does trochanteric bursitis feel like?
Trochanteric bursitis typically causes a deep ache or sharp tenderness on the outer side of your hip. You may also feel it spreading down the outside of your thigh. It tends to be worse at certain times.
Some people notice the pain started slowly, perhaps after walking longer distances or changing their exercise routine. Others cannot find a trigger at all. Either way, this pattern of pain on the outer hip is the hallmark of GTPS.
What causes trochanteric bursitis?
GTPS is caused by too much load, or repeated load, on the structures around the greater trochanter. These include the bursae (fluid-filled cushions), the gluteal tendons and the iliotibial band. Several factors can play a part.
Repeated activity, such as running or hill walking, is a common trigger. But in many cases, the root issue is how your body spreads load when you stand and move. A pelvic tilt, a slight difference in leg length, or a change in your walking pattern caused by a problem elsewhere can all increase strain on one trochanter. This is where whole-body alignment becomes relevant.
Why does alignment matter for outer hip pain?
Alignment matters because your body works as a connected chain, from your feet through your knees, hips, pelvis and spine. When one link in that chain is off, another area makes up for it. Pain often shows up at the point doing the extra work, not at the original problem.
With trochanteric bursitis, the outer hip is often the area taking the extra load. A tilted pelvis may force one gluteal tendon to work harder. A stiff ankle, or a knee that does not fully straighten, can change your stride and pile stress onto the greater trochanter with every step. If imaging looks only at the hip on its own, and only while you are lying down, it may miss these factors completely.
Standard imaging such as X-ray, CT or MRI is usually done while you lie flat. In that position, gravity is removed, muscles relax, and the alignment changes your body shows when upright and bearing weight may disappear. That is why a scan can come back looking normal even when the pain is very real.
What helps with trochanteric bursitis?
Most treatment for trochanteric bursitis of the hip is conservative, which means it does not involve surgery. Your clinician may recommend physiotherapy focused on strengthening the gluteal muscles, changes to your activity, or a short-term change in how you load the hip. Some people benefit from a steroid injection to reduce inflammation.
The key is finding what is driving the overload. If there is an underlying alignment issue, such as a pelvic shift or a functional leg length difference, treatment can be aimed more precisely when your clinician has the full picture. Standing, weight-bearing imaging gives that picture.
Before you start treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in your pelvis, your legs or your spine changes what will actually help.
When is MRI the better choice? EOS imaging shows bones, joints and alignment very clearly. But if your clinician suspects a soft-tissue problem, such as a gluteal tendon tear, a labral issue or nerve involvement, MRI is usually the better tool. The two types of imaging answer different questions and can work well together.
Not sure whether your outer hip pain needs an alignment assessment? Talk to us first, free of charge, before you plan any travel to London.
Book a free video consultationHow is an EOS scan different for trochanteric bursitis?
An EOS scan captures your entire skeleton in one image while you stand naturally. This means the scan shows your real alignment: how your pelvis sits, whether your legs are the same length, and how your spine, hips and knees relate to each other under gravity.
For someone with outer hip pain, this can tell a lot. A standard hip X-ray might show a joint that looks normal. An EOS image of the whole body might show that the pelvis is tilted, shifting extra load onto the painful side. Or it might show that a subtle knee alignment issue is changing the way you walk. These findings give your treating clinician something clear to act on.
The EOS system also uses about 90% less radiation than a standard X-ray, around ten times less. The scan itself takes just a few seconds while you stand still in the machine. No injections, no enclosed space, no preparation needed.
ScanAlign is a diagnostic imaging clinic at 19 Harley Street, London. We provide the imaging and the detailed report. Treatment decisions are made by your own clinician, physiotherapist or surgeon, who can use the findings to guide your care. You can learn more about how EOS whole-body imaging works.
Common questions about trochanteric bursitis and imaging
Trochanteric bursitis refers specifically to inflammation of the bursa at the greater trochanter. GTPS (greater trochanteric pain syndrome) is the wider, more accurate term. It includes bursitis but also covers gluteal tendinopathy and other causes of outer hip pain. Most clinicians now use GTPS because the bursa alone is rarely the whole story.
Yes. A changed walking pattern, whether from a knee problem, a foot issue or a spine condition, can change how load is spread across your hip. Over time, this added stress on the outer hip can contribute to bursitis or tendinopathy.
It can be a contributing factor. When the pelvis is tilted, one hip may carry more load than the other. This imbalance can overwork the gluteal tendons on the loaded side and lead to pain at the greater trochanter. Standing imaging can help show whether a pelvic tilt is present. You can read more about hip alignment assessment.
A standard hip X-ray may show bony changes near the greater trochanter, but it does not show the bursa or tendons directly. Its main role is to rule out other causes such as arthritis or a fracture. An EOS standing scan adds alignment information that a standard X-ray taken lying down cannot give.
MRI is the best tool if your clinician suspects a gluteal tendon tear or other soft-tissue damage. EOS imaging is better for assessing your skeletal alignment and how your bones and joints relate to each other when standing. The two scans answer different questions and can work together.
Yes. The EOS system uses about 90% less radiation than a standard X-ray, around ten times less. For more detail on safety, preparation and what to expect, visit the FAQs page.
No. ScanAlign is a private, self-pay clinic. You can book directly without a referral from your doctor. We offer a free video consultation first, so we can make sure an EOS scan is the right step for you.
The price for patients travelling from abroad is confirmed during the free video consultation. You can find more information on the ScanAlign FAQs page.
It can contribute. Even a small difference in leg length changes the way you walk and stand. The side with the longer leg may take more load through the hip, increasing strain on the gluteal tendons and bursa. A full-body standing scan can measure leg length accurately while you bear your weight naturally.
You stand in the EOS machine wearing comfortable clothing with no metal. The scan takes a few seconds and captures your entire skeleton from the front and side at the same time. There is no enclosed tube and no injections. Your images are reviewed by a specialist, and a detailed report is produced for you and your clinician.
Wondering if your hip pain is an alignment problem?
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Sources
- Grimaldi, A. & Fearon, A. (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 910-922.
- Segal, N.A. et al. (2007). Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation, 88(8), 988-992.
- NHS. Hip pain in adults. nhs.uk. Available at: https://www.nhs.uk/conditions/hip-pain/
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.