Trochanteric Bursitis

Anatomy:

A bursa is a small fluid-filled sac that sits near a bone. It cushions and protects nearby tissues when they rub against or slide over bones. Bursitis happens when a bursa gets irritated and swollen. In the case of trochanteric bursitis, bursitis occurs due to an exaggerated movement of the gluteus medius tendon over the outer femur.

Definition:

Inflammation of trochanteric bursa is one of the most common causes of hip pain. The normally paper-thin bursal wall thickens and loses its lubrication, resulting in outer thigh pain. Most of the cases of trochanteric bursitis are caused by an abnormal gait due to various conditions, such as knee arthritis, ankle sprains, leg length discrepancy, back pain and others.

Symptoms:

- Outer thigh pain

- Local tenderness

- Difficulty walking

- Difficulty sleeping on the affected side

- Morning stiffness

Examination:

Each patient is examined for local tenderness at the greater trochanter area and during hip rotation, as well as for low back flexibility and gait abnormality.

Imaging Studies:

Plain X-rays of the hip should be performed to exclude other causes of hip pain. Occasionally, calcifications may be seen in the region of the bursa or adjacent soft tissue. If symptoms persist for six to eight weeks despite treatment, then CT or MRI tests of the low back should be ordered. Ultrasound may be used in diagnosing a suspected gluteus medius tendon tear.

Regional Anesthetic Block:

Regional injection of a local anesthetic, such as lidocaine, can be very helpful in order to distinguish trochanteric bursitis from pain referred from the back. Relief of pain with the injection is consistent with a diagnosis of bursitis.

Treatment:

- Heat treatments applied to the outer thigh for 15–20 minutes to prepare the area for stretching

- Passive stretching: cross-leg pulls to reduce the pressure over the bursa

- Knee-chest pulls to increase the flexibility of the lower lumbosacral spine.

- Therapeutic ultrasound

- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve, Motrin, etc. can be prescribed at full dose for the first four weeks

- Correction of underlying gait disturbances (shoe lift for leg discrepancy, knee brace, high-top shoes for ankle support or custom-made food orthotics)

- Reduce weight-bearing activities (less standing or temporary crutches)

- Weight loss for overweight patients

- Using a cushioned seat to decrease pressure on the joint

- Injection of glucocorticoids (steroids) in the trochanteric bursa is very effective in reducing the acute inflammation

Surgery:

Surgery for trochanteric bursitis is rarely performed. It may be considered in patients who have had refractory symptoms for more than one year despite steroid injections. A surgical approach usually includes release and lengthening of the iliotibial band over the greater trochanter and excision of the subgluteal bursa.