Hip bursitis (trochanteric bursitis) is the usual name for pain on the outside of the hip, yet most of it is damage to the gluteal tendons that attach there. In St. Louis we confirm it on ultrasound and treat the tendon with platelet-rich plasma (PRP), targeted strengthening and metabolic repair instead of repeated cortisone shots.
The typical patient is a woman in her fifties or sixties who cannot lie on her side at night, winces climbing stairs, and has had two or three “bursitis shots” that each worked for a shorter time than the last. Nobody told her the bursa was rarely the main problem. The gluteus medius and minimus tendons, which hold the pelvis level every time she takes a step, have been wearing out underneath it.
That matters because the treatments are different. A bursa that is inflamed responds to steroid. A tendon that is degenerating gets weaker with steroid. Treat the wrong structure and you get a cycle: shot, relief, relapse, another shot, a thinner tendon.
Greater trochanteric pain syndrome (GTPS) is the umbrella name for outer hip pain centered on the bony point at the side of the hip, the greater trochanter. It covers gluteal tendinopathy, partial tears of those tendons, and bursitis. Imaging studies keep finding the same thing: the tendon is the main driver, and the bursa is often a bystander. A 2025 review put it plainly, noting that gluteal tendinopathy is often misdiagnosed as trochanteric bursitis.
Typical signs of outer hip pain from the gluteal tendons:
Groin pain points to the hip joint itself, and pain running from the buttock past the knee can be the spine. Ultrasound in the exam room sorts this out. Our earlier article on trochanteric bursitis and lateral hip pain covers the basics.
The tendons wrap over the bony trochanter like a rope over the edge of a table. Squeeze the rope against the edge long enough and it frays. Three forces decide how fast:
For the tendon problem underneath most hip bursitis, the trials say yes, over time. In a double-blind randomized trial of 80 patients with gluteal tendinopathy, symptoms lasting over a year, a single PRP injection into the tendon under ultrasound beat a single cortisone injection at 12 weeks. At two years, the PRP group kept improving, while the cortisone benefit peaked at six weeks and was gone by 24 weeks. Patients who failed cortisone and then crossed over to PRP improved as well. A meta-analysis comparing the two found PRP more effective at about two years.
Platelets are the repair workers. Concentrated from your own blood in an FDA-cleared device, they release growth signals that call in new cells and rebuild collagen. We place them into the damaged section of tendon under ultrasound guidance. Read more on our tendon injection and PRP injections pages. For partial tears or tendons that failed PRP, bone marrow concentrate adds the general contractor that organizes the crew.
The procedure is done under local anesthetic. You are awake, there is no sedation, and most patients drive themselves home. Expect soreness for about 48 hours as the repair starts. Protect the area for the first few days and follow the rehab plan.
The number of injections follows clinical need. Some feel better in three weeks; others need a second or third treatment, decided by how the tissue responds. You can’t make a carrot grow faster than it grows. Tendon remodels over months.
A 2025 systematic review named exercise and education as the core of gluteal tendinopathy care. We agree, and we build the rest around it. Lifestyle and behavioral work is 40 to 50 percent of our protocol:
Dr. Padda is a licensed physician and surgeon. A full-thickness gluteal tendon tear with real weakness, a limp that will not resolve, or a tendon pulled off the bone belongs with a surgeon. Orthobiologics are the bridge between failed conservative care and surgery, and for most partial damage that bridge is where the problem gets solved.
More on this condition from Dr. Padda on YouTube:
Pain in the groin rather than the side of the hip usually comes from the joint itself. See hip arthritis treatment.
They overlap, and they are often confused. Most outer hip pain labeled bursitis comes from the gluteal tendons. Ultrasound shows which structure is damaged.
Lying on that side presses the tendon against bone. Lying on the other side lets the top leg drop, which stretches and compresses the same tendon.
Each shot tends to work for a shorter time, and steroid weakens tendon. In head-to-head trials, the cortisone benefit was gone by 24 weeks while PRP kept working at two years.
Soreness lasts about 48 hours. Many patients notice change within weeks, and gains keep building for months.
No. We use local anesthetic, you stay awake, and most patients drive themselves home.
PRP is not billed to insurance. HSA and FSA funds are generally eligible.
If the bursitis shots keep wearing off sooner, stop treating the bursa and look at the tendon. Over 90% of our accepted case-study patients see significant improvement. That is a practice-reported figure from our own population, not a trial outcome, and individual results vary. Request the orthobiologics guide above, or call our office at 4477 Woodson Rd in St. Louis at (314) 481-5000 and we will show you on ultrasound what is actually hurting.
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