Hip Bursitis: Lateral Hip Pain (Trochanteric/Abductor) and Iliopsoas

“Hip bursitis” is one of the most over-used labels in orthopaedics — and it actually describes two completely different problems. The common one is pain on the outside of the hip (lateral hip pain). The much less common one is pain in the front of the hip and groin. They have different anatomy, different causes, and a different exam — so the first step is always figuring out which one you actually have.

Two different problems, one label

The word “bursitis” gets attached to both of these:

• Lateral hip pain — trochanteric / abductor bursitis (GTPS). Pain over the bony point on the side of the hip. This is the common one — the “I can't sleep on that side” patient.
• Groin pain — iliopsoas bursitis. Pain in the front of the hip and groin, usually with lifting the leg. Much less common, and typically from overuse or a sports injury.

Lateral hip pain: trochanteric (abductor) bursitis

This is the lateral hip pain patient. The relevant anatomy lives on the outside of the hip:

• The gluteus medius and gluteus minimus — your hip abductor muscles, which stabilize the pelvis when you stand and walk
• The greater trochanter — the bony prominence on the side of the femur where those muscles attach
• The trochanteric bursa — the cushion that sits over that bony point

The classic presentation is unmistakable:

On exam the spot directly over the greater trochanter is tender, and the pain is often reproduced with resisted abduction (pushing the leg out against resistance), single-leg stance, or a Trendelenburg test. X-rays of the hip are usually normal; an MRI, if we get one, may show bursitis along with gluteus medius tendinosis or even a partial or full-thickness tear of the abductor tendons.

Why we now call it GTPS, not just “bursitis”

The old term was “trochanteric bursitis,” which implies a simple inflamed bursa. The reality is that most patients actually have a tendon problem — irritation, degeneration (tendinosis), or partial tearing of the gluteus medius and minimus — with the bursa irritated secondarily. That's why the more accurate modern term is greater trochanteric pain syndrome (GTPS).

Three causes to rule out

When I see lateral hip pain, I'm really sorting between three sources. Getting this right is the whole game:

1. A primary flare of the abductors. A genuine, direct bursitis/tendinopathy from overuse or trauma — the muscles and bursa on the side of the hip are themselves the problem. This is what most people picture, and it responds well to treatment.
2. Referred pain from the lower back. Sometimes the abductors are flaring because they're protecting and compensating for a problem in the lumbar spine. In these patients the lateral hip is where it hurts, but the lower back is where the trouble actually starts — so we have to evaluate the back.
3. Pain from inside the hip joint. Arthritis, a labral tear, or impingement (FAI) inside the joint can refer pain to the side of the hip and masquerade as bursitis. If the hip joint itself is the driver, no amount of treatment aimed at the bursa will fix it.

Primary bursitis is usually from trauma or overuse. But because the back and the joint can both masquerade as “bursitis,” an honest back and hip evaluation — not just a shot into the sore spot — is what gets patients better for good.

Groin pain: iliopsoas bursitis

This is the anterior groin pain patient — a different problem entirely. The iliopsoas is your main hip flexor, and its tendon runs directly across the front of the hip. The iliopsoas bursa sits between that tendon, the joint capsule, and the front of the socket (the anterior acetabulum).

The classic complaint is “pain in my groin when I lift my leg”:

On exam, the pain is reproduced with resisted hip flexion, seated hip flexion, or a straight-leg raise. Imaging can be subtle — an MRI may show iliopsoas bursitis, tendinitis, or a small fluid collection, but often the findings are mild. Iliopsoas bursitis is much less common than lateral hip pain; we see it from time to time, usually with overuse or a sports injury.

How I treat hip bursitis

The large majority of hip bursitis — lateral or iliopsoas — is treated without surgery, and most patients improve. The starting point is the same:

For lateral hip pain in particular, a structured physical therapy program aimed at the abductors is the foundation — because, as above, the underlying problem is usually the tendon. When therapy, medication, and activity modification aren't enough, the next step is an injection.

Cortisone vs. PRP injections

When a flare won't settle, I offer two injection options for both abductor (lateral) and iliopsoas bursitis:

• Cortisone — for lateral hip pain, a cortisone injection into the trochanteric region is often very helpful and can break a stubborn flare. It also helps confirm the diagnosis: good relief points to the bursa/tendon as the source rather than the back or the joint.
• PRP (platelet-rich plasma) — a regenerative option I offer for patients who prefer to avoid cortisone or who have a degenerative tendon component, which is common in GTPS.

For iliopsoas bursitis, the bursa sits deep in the front of the hip, so if an injection is needed it's usually done under ultrasound guidance for accurate placement — though in practice most iliopsoas cases settle without one.

What patients tell me

Hip bursitis tends to show up in a few recognizable ways:

The patient who's had a shot or two that “didn't last” is the one I think about most — because that pattern usually means we haven't yet treated the real source, whether that's a degenerated abductor tendon, the lower back, or the hip joint.

Next step

If you've been told you have hip bursitis — especially if it keeps coming back — the most useful thing is a proper evaluation that sorts out where the pain is actually coming from: a primary abductor flare, the lower back, or the hip joint itself. Most patients do very well with a focused strengthening program and, when needed, a well-placed cortisone or PRP injection. And if the workup shows the real driver is arthritis inside the joint, we'll talk honestly about that instead.

If lateral hip or groin pain is keeping you up at night, that's a conversation worth having — request a consultation and we'll get to the bottom of it. You can also read more about common causes of hip pain in women, where GTPS is one of the most frequent culprits.