In an older adult with antalgic gait and hip pain with trochanteric tenderness, what is the most common cause?

• A. Bone cancer
• B. Trochanteric strain
• C. Trochanteric bursitis
• D. Osteoarthritis

Answer: (C)

Pain on the outside of the hip with tenderness over the greater trochanter in an older adult is most commonly caused by trochanteric bursitis. The bursa that sits over the greater trochanter can become inflamed from overuse, degenerative changes in the hip, or minor trauma. This produces localized lateral hip pain and a tender point at the greater trochanter, which often leads to an antalgic gait as the person shifts weight away from the painful area.

This presentation helps distinguish it from other possibilities. Osteoarthritis of the hip typically causes deep groin or anterior thigh pain, stiffness after rest, and reduced hip range of motion, rather than focal tenderness over the trochanter. A trochanteric strain would usually follow a more identifiable acute injury and presents with tenderness and weakness related to the involved structures, but is less common as the sole cause in an older adult with a gradual, localized lateral hip pain. Bone cancer would be less likely in this scenario and would usually raise concern for constitutional symptoms or a more persistent, progressive deep bone pain with imaging findings.

Understanding the localization of pain and tenderness over the greater trochanter helps point toward trochanteric bursitis as the most likely source in this scenario.