TROCHANTERIC BURSITIS
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What is Trochanteric Bursitis?
This is a type of hip inflammation.
More specifically, its inflammation of the bursa covering the Greater Trochanter.
To better understand this condition, lets quickly review the anatomy. The greater trochanter is a part of your femur bone that can be felt as a prominent bump on the side of your hip (if you rub your hand along the outside of your hip you feel a bump, thats the greater trochanter). Our body naturally forms padding around all the bumpy parts of our bones to protect the muscle and tendons that glide over top of them. A bursa is a fluid filled sac that acts as this padding, and you can find these bursa all over the body, wherever you feel a pointy bone.
In the hip, there is an tendon that runs overtop the greater trochanter, called the IT band (iliotibial band), and as it moves over this bump you can image that a lot of friction could develop, eventually leading to inflammation. This inflammation is often commonly seen in runners because their workouts exceed the normal amount of friction that our body is built to withstand. But this condition can occur in anyone. Inflammation develops within the hip bursa and is called trochanteric bursitis.
The condition is 4 times more common in women and usually occurs in people 30 - 50 years old.
How is Trochanteric Bursitis diagnosed?
People report hip pain along the outside of the hip, with specific point tenderness over the bony prominence of their hip . People often feel pain while lying on the affected side and when climbing stairs.
Bursitis typically begins as minor pain that gets worse over time, and is made worse with activity. There is rarely a specific event or injury that initiates the pain.
On exam, pushing on the inflamed bursa causes a lot of pain. Also spreading the leg to the side (hip abduction) causes pain, and abduction combined with hip flexion and external rotation can really increase the pain. Also, the Ober test, which looks at the tightness of the IT band, often causes pain because this band is causing friction over the bursa.
X-rays are often ordered to rule out other injuries that may cause similar hip pain (like hip arthritis or a fracture of the greater trochanter), however, true bursitis will not show up on x-ray.
How is Trochanteric Bursitis treated?
Treatment of trochanteric bursitis should proceed in a stepwise fashion, from less invasive to more involved.
Bursitis is usually successfully treated with anti-inflammatories, stretching of the IT band and gluteal muscles, and resting from any aggravating activity. A formal physical therapy program may be helpful if pain continues despite therapy. Sometimes a steroid injection is used to cool down the inflammation. Surgical removal of the bursa, or lengthening of the IT band can be performed in cases of refractory pain, but should be only considered once conservative treatments have failed after a few months.
What is the long term outcome?
The patients typically respond very well to nonsurgical treatment. In the rare case the surgery is required, treatment success is more variable. A lot of patients will report resolution of symptoms following surgery, however a small percentage will complain of continued pain, likely from the development of scar tissue that causes irritation.
References
1) Aaron DL et al. Four common types of bursitis: diagnosis and management. JAAOS 2011; 19: 359-67. full article. review.
2) Kingzett-Taylor A et al. Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings. AJR 1999; 173: 1123-6. full article. MRI demonstrates some partial/microtears of glut medius/min, suggest many troch bursitis is actually insertional tendinopathy.
3) Bird PA et al. Prospective evaluation of MRI and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum 2001; 44: 2138-2145. full article. even more tendinopathy than article 2: MRI shows partial/microtears of glut medius/min 80%, and bursitis alone only 8%.
4) Ege Rasmussen KJ et al. Trochanteric bursitis: treatment by corticosteroid injection. Scan J Rheumatol 1985: 14; 417-420. full article. clinical diagnostic tests.
5) Schapira D et al. Trochanteric bursitis: a common clinical problem. Arch Phys Med Rehab 1986; 67: 815-817. full article. nonop rx, steroid and pt are effective rx.
6) Kagan A. Rotator cuff tears of the hip. CORR 1999; 135-140. full article. chronic bursitis may be abd tear treated effectively with debridement.