Trochanteric Bursitis

Evidence: Promising, Mixed Evidence — ASPN 2024: Level I · Grade C

CAUSES

• Repetitive friction over the outer hip from walking, running, or stairs
• Tightness of the iliotibial (IT) band
• Weakness or partial tearing of the gluteus medius and minimus tendons
• Differences in leg-length
• Direct trauma to the side of the hip

SYMPTOMS

• Aching pain over the outer hip, tender to touch
• Pain that worsens lying on the hurt side at night
• Discomfort climbing stairs or standing up from a chair
• A limp with prolonged walking

IMAGING

Ultrasound or MRI of the hip is used to look for swelling in the bursa, or for tears or degeneration of the gluteal tendons, and to rule out other causes of lateral hip pain.

CAN PRP HELP?

Evidence is mixed. Some studies show PRP outperforming cortisone injections over the long run, while a well-designed placebo-controlled trial found no real advantage over a saline injection. PRP may a reasonable option once physical therapy and activity changes haven’t been enough, but it’s important to set reasonable expectations given the inconsistent research.

Leukocyte Preparation: Leukocyte-Rich

Dosing: Series Often Recommended (2–3 injections)

Target Platelet Dose in Studied Protocols: 5.8–6.7 billion platelets in the gluteal-tendinopathy trials behind this grade.

ASPN 2024 CONSENSUS GUIDELINE

ASPN groups trochanteric bursitis together with gluteal tendinopathy — the two commonly coexist as “greater trochanteric pain syndrome” — and grades the combined evidence Level I, Grade C: promising but inconsistent RCTs, with the gluteal-tendon data stronger and more durable (sustained to 2 years) than the hamstring data graded under the same row. Because this is fundamentally a tendon/enthesis target rather than a joint, ASPN’s tissue-based default favors leukocyte-rich PRP, which corrects the leukocyte-poor default we’d previously listed here.

Sources: D’Souza et al. (ASPN Consensus), Journal of Pain Research, 2024 · Atchia et al., Journal of Bone and Joint Surgery (Am), 2025 · Migliorini et al., British Medical Bulletin, 2021

FREQUENTLY ASKED QUESTIONS

Is my outer hip pain from bursitis or from the gluteal tendons?

Often both at once — ASPN groups trochanteric bursitis together with gluteal tendinopathy as “greater trochanteric pain syndrome,” since the two commonly coexist. Ultrasound or MRI of the hip differentiates bursal fluid from tendon tearing or degeneration.

Does PRP outperform a cortisone shot for outer hip pain?

The evidence is genuinely mixed, which is reflected directly in ASPN’s Level I, Grade C rating. Some studies show PRP outperforming corticosteroid injections over the long run, while a well-designed placebo-controlled trial found no real advantage over a saline injection. PRP can be a reasonable option once physical therapy hasn’t been enough.

Leukocyte-rich or leukocyte-poor PRP for trochanteric bursitis, and how many injections?

Leukocyte-rich, typically as a series of two to three injections. Because this is fundamentally a tendon/enthesis target rather than a joint, ASPN’s tissue-based default favors leukocyte-rich PRP.