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Trochanteric Bursitis

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Trochanteric Bursitis

WHAT IS IT?

Trochanteric bursitis involves the swelling of the synovial bursa of the greater trochanter located in the part of the deep femur close to the fascia lata.

Although the bursa tissue may swell causing pain, the tissue enclosing the trochanter may also suffer and this may contribute to the pain symptoms (Greater Trochanteric Pain Syndrome could be a more general way to define this pathological condition). The  tendons of the gluteus medius and gluteus minimus which insert on the greater trochanter are often related with this complaint. 

CAUSES

This pathology occurs most frequently in middle-aged and elderly women. It may be associated with problems with the lumbar spine, intra-articular hip pathology, rheumatoid arthritis or length discrepancy concerning lower limbs. It may also appear following prosthetic hip surgery as a result of scar tissue or irritation due to the surgical sutures (stitches) or to the prosthetic material itself. It may also occur due to friction in the joint, to micro trauma injuries from repetitive movements or to trauma injury processes (such as a direct blow to the trochanter area). 

SYMPTOMS

It is characteristic to feel pain in the side of the hip (the greater trochanter area) and this may spread down the thigh as far as the knee, running the length of the iliotibial band.

This pain may become more intense when lying or sitting on the side affected, or when crossing the affected leg over the other, when going up stairs or after spending a long time sitting or lying down. 

DIAGNOSIS

Diagnosis generally involves clinical examination. In addition to the symptoms reported by the patient, a proper physical examination is also required.

Hip mobility is not normally affected. The patient may adopt a painless gait leading to a limp. Touching the trochanter area is painful. Other specific actions may help to consider whether other structures such as the aforementioned tendons of the gluteus medius and/or gluteus minimus are also involved in the process.

In certain cases, other additional tests such as a simple X-ray (calcification in the trochanter area), an ultrasound scan (distended bursa, swellings in the gluteal tendons) or an MRI scan (distended bursa, bone oedema, tendon injury) may help to diagnose more accurately Greater Trochanteric Pain Syndrome.

TREATMENT

Treatment tends to be conservative or non-surgical. Most patients see their syndromes alleviated with one or more of the following therapy options:

  • Stretching exercises for the iliotibial band
  • Strengthening of the gluteal muscles
  • Anti-inflammatory medication taken orally
  • Injections to the trochanter area (cortico-steroids or PRGF®-Endoret®monitored by ultrasonic scanner)

The participation of physiotherapists in this pathology in terms of both therapy and preventive and educational actions is highly important.

Surgical treatment should only be considered in cases where all the conservative options have been implemented. This treatment normally consists of removing the swollen bursa and releasing, relaxing or extending the iliotibial band. It may also include repairing the injured tendons.

This surgery has classically been performed by making an incision into the side aspect of the root of the muscle. In recent years, due to the growth in hip arthroscopy, the surgery has been performed using endoscopic surgery.


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