The Journal of Bone and Joint Surgery (American). 2008;90:284-294.
doi:10.2106/JBJS.G.00257
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Morphology of the Bursae Associated with the Greater Trochanter of the Femur

Stephanie J. Woodley, BPhty, MSc, PhD1, Susan R. Mercer, BPhty(Hons), MSc, PhD2 and Helen D. Nicholson, BSc(Hons), MBChB, MD1

1 Department of Anatomy and Structural Biology, University of Otago, P.O. Box 913, Dunedin 9054, New Zealand. E-mail address for S.J. Woodley: stephanie.woodley{at}anatomy.otago.ac.nz
2 School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia

Investigation performed at the University of Otago, Dunedin, New Zealand

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Abnormalities of the bursae in the vicinity of the greater trochanter have been implicated in the pathogenesis of lateral hip pain. The purpose of the present study was to investigate the detailed morphology of the bursae associated with the greater trochanter of the femur.

Methods: The bursae deep to the tendons of each of the gluteal muscles were examined in eighteen embalmed human hips with use of macrodissection and histological techniques. The specimens were obtained from eight female and seven male donors who had had a mean age of seventy-eight years at the time of death.

Results: A total of 106 bursae were identified in ten different locations, with an average of six bursae per hip. As many as four bursae were present beneath the gluteus maximus muscle and the fascia lata, including those normally thought of as the "trochanteric" bursae and the gluteofemoral bursa. Two bursae typically were found beneath the tendon of the gluteus medius muscle: the anterior subgluteus medius bursa and the piriformis (posterior subgluteus medius) bursa. In the majority of cases, a single bursa was located deep to the gluteus minimus tendon, although two different bursae were identified: the subgluteus minimus bursa and the secondary subgluteus minimus bursa. All of these bursae demonstrated a synovial lining, which was predominantly areolar in type.

Conclusions: The present study revealed that numerous bursae are intimately associated with the greater trochanter and that at least two bursae are associated with each of the gluteal tendons.

Clinical Relevance: The findings of the present study contrast with traditional anatomical descriptions and clinical teaching regarding the existence of a single "trochanteric" bursa. New information is also provided regarding the bursae located beneath the tendons of the gluteus medius and gluteus minimus. Improved knowledge of bursal anatomy will assist clinicians in accurately locating these structures.


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