Hip bursitis, now understood as Greater Trochanteric Pain Syndrome.

Hip bursitis is a common cause of pain over the outside of the hip. Modern imaging and research have shown that the trochanteric bursa is rarely the sole problem - most people also have tendinopathy of the gluteus medius or minimus and irritation of the iliotibial band. Because it is a group of conditions rather than a single one, the umbrella term Greater Trochanteric Pain Syndrome (GTPS) is now used. It is the most common cause of lateral hip pain in middle-aged adults, and women are affected more often than men.

The diagnosis is usually clinical. Tenderness directly over the greater trochanter, pain lying on the affected side, and pain on single-leg stance or stairs are the classic features. A short examination that includes palpation, a Trendelenburg test, FABER and resisted abduction is usually enough. Imaging is selective - an ultrasound scan can confirm bursal fluid or tendinopathy and is often the first-line image, while MRI is reserved for atypical presentations, suspected tendon tears or pre-surgical planning.

The LEAP trial was a UK-relevant randomised controlled trial published in the BMJ in 2018 comparing three approaches to gluteal tendinopathy: education plus loaded exercise, a corticosteroid injection, and a wait-and-see approach. At eight weeks the injection and exercise groups were both better than wait-and-see. At 52 weeks the exercise group had the best global rating of change and pain scores. It reshaped UK practice by moving loaded physiotherapy to the front of the queue, ahead of injection.

Yes, particularly for short-term pain relief. An image-guided injection into the bursa or peritendinous space typically gives good relief for weeks to a few months and can be a helpful bridge to physiotherapy for people whose pain is limiting exercise. The evidence suggests that in the medium to long term, a structured loading programme outperforms injection alone. Repeated injections carry a small risk of tendon weakening and are used with care.

Extracorporeal shockwave therapy is a good option for tendinopathy-dominant GTPS that has not settled with physiotherapy. A typical course is three to five weekly sessions delivered through the skin, without anaesthetic. Trials show meaningful pain reduction and functional improvement in gluteal tendinopathy, and it is commissioned in a number of UK specialist musculoskeletal services. It is not a first-line treatment but a solid second-line option before injection or surgery.

Surgery is uncommon and reserved for a small minority. It is typically considered when severe pain persists despite at least six to twelve months of good non-operative care, or when imaging confirms a significant gluteus medius or minimus tendon tear. Options include endoscopic bursectomy, iliotibial band release and open or endoscopic gluteal tendon repair. Outcomes are generally good in carefully selected cases and the decision should be made in a specialist orthopaedic clinic.