Trochanteric Bursitis

What are the signs & symptoms of trochanteric bursitis?


What is trochanteric bursitis?

Trochanteric bursitis is when the trochanteric bursa becomes inflamed resulting in discomfort and pain on the outside of the hip joint. The suffix ‘itis’ can be found at the end of numerous medical terms and it indicates a form of inflammation. Common conditions are: arthritis, colitis, rhinitis and others. Signs of inflammation in the body include pain, warmth, swelling, redness often called erythema. Inflammation can commonly be accompanied by a reduction of function in the particular joint that is affected.

In the case of trochanteric bursitis there is inflammation of the bursa located on top of the greater trochanter found on the outside of the hip joint. A bursa is a fluid-filled sac that provides cushion, lubrication, and acts as a shock absorber between bones, tendons and muscles near the joints. There are over 150 bursae found around the body which are covered with synovial cells that reduce friction and allow joints to move freely without causing any pain.

The two-bursa involved in the case of trochanteric bursitis are the sub-gluteus medius bursa and the sub-gluteus maximus bursa. The first is located between the greater trochanter and below the insertion of the gluteus medius tendon and the second one is found between the greater trochanter and the insertion of both the gluteus medius and maximus muscles.

What are the signs & symptoms of trochanteric bursitis?

  • Pain on the outer and upper most region of thigh and tenderness around the outside of the hip joint. The pain can sometimes radiate down the front and outside portion of the thigh.
  • Swelling, bruising, redness and tenderness on touch.
  • General hip stiffness and decreased range of motion.
  • A clicking or snapping sensation felt on the outside of the hip or deep in the joint.
  • Pain when lying on the affected side especially on hard surfaces, which can go on to cause sleep disturbance due to pain development.
  • Worse when ascending or descending stairs, standing on the affected side or standing for too long.
  • Knee pain due to changes in walking gait and movements to decrease painful stimuli from the trochanteric bursa.
  • Lower abdomen, groin, buttock and low back pain.
  • Inability to walk without limping (antalgic gait).

Common causes of trochanteric bursitis?

Trochanteric bursitis affects certain athletic populations and commonly those aged 50 and above with women being affected slightly more than men. Trochanteric bursitis is often seen in athletes that do repetitive hip movements and in contact sports such as: cyclists, runners, ice hockey, football, rugby and others.

Common causes include:

  • Sudden increase in training load.
  • Gluteal, hamstring, quad, abductor, adductor and hip flexor muscle weakness, with the gluteal muscles being the most important ones.
  • Tightness of the tensor fasciae latae (TFL) which attaches to the iliotibial band (IT).
  • Repetitive movements or injuries of the hip area.
  • Conditions such as: rheumatoid arthritis (RA), gout, scleroderma.
  • Skin infections following open wound injuries or animal and insect bites in immunocompromised people ( individuals with a weakened immune system).
  • Direct trauma to the hip area.
  • Previous hip surgeries.
  • Bone spurs and calcium deposit crystals in the tendons.

Predisposing factors include:

  • Gender- women are affected more than men.
  • Overweight- more pressure and stress through the hip joint and surrounding structures.
  • Incorrect daily position (posture, scoliosis, leg length discrepancy).
  • Muscle overuse around trochanteric bursa.
  • Direct trauma to the greater trochanter (falls, road traffic collisions, sports injuries)
  • Hip osteoarthritis which will change the biomechanics of the hip joint thus the loading through the muscles, tendons and bursae.
  • Lumbar and sacroiliac joint spondylosis which will again change the biomechanics of walking.
  • Repetitive movements, change in type and amount of training and training in a bad posture.
  • Hip prosthesis.
  • Inflammatory conditions and bacterial infections.

How is trochanteric bursitis diagnosed?

The diagnostic procedure for trochanteric bursitis involves a detailed case history of the patient’s daily habits, hobbies and training patterns. This is followed by the accumulation of all the clinical characteristics from a detailed standing, active and passive examination. Inspection and palpation of the area and orthopedic provocative tests followed by stability and muscle strength testing all help to diagnose the problem area.

Testing of the hip includes:

  • A good palpation of the hip joint and the surrounding tissues (gluteal muscles, TFL, ITB, quads and hamstrings).
  • A full active range of motion of the hip joint (flexion, extension, internal & external rotation, abduction and adduction).
  • A full passive range of motion of the hip joint
  • Strength testing of the surrounding muscles against resistance (might be against the resistance of the practitioner, against a resistance band or with the use of some weights)
  • Stability testing such as single leg stance, squat and lunge and a gait assessment and analysis
  • Orthopedic provocative testing.
  • Further examination of the lumbar spine, sacroiliac joints, pubic symphysis, knee, ankle, feet and muscle bellies of the surrounding muscles.

A thorough examination will help with making the right diagnosis as other common conditions listed below can often present with similar signs and symptoms to trochanteric bursitis:

  • ITB syndrome
  • Gluteus Medius tendon dysfunction
  • Meralgia paresthetica
  • Referred pain from abdominal organs, knee, low back and sacroiliac joint

What are the treatment options for trochanteric bursitis?

Different treatment options may include a conservative treatment with the use of medication and physical and manual therapy, the option of medical management or surgical treatment.

Conservative Treatment

Medication. Prescribed nonsteroidal anti-inflammatories (NSAIDs) from your GP/doctor can aid in inflammation and pain control.

Physical and Manual Therapy. Physical therapy will focus on unloading any excess pressure on the bursa using isometric, eccentric and concentric loading exercises. Stretches and mobilization techniques of the hip joint along with the knee, ankle, sacroiliac and low back. Correction of the biomechanical chain of the lower limb can help to correctly unload the tendons and compression through the trochanteric bursa. Further techniques may include deep tissue, kinesiology taping, acupuncture and contrast bath therapy to improve the blood flow and decrease the swelling.

Corticosteroid Injection. If pain and inflammation levels are difficult to manage and there is a lack of progression with your injury, your doctor/practitioner may decide to investigate a cortisone injection. This comprises a local anesthetic and a steroid injection to decrease inflammation and improve healing time frames.

Medical Management

Antibiotics. In case of an infectious cause of trochanteric bursitis, a laboratory test of the bursa fluid will be used, and an intravenous antibiotic therapy may be prescribed.

Surgical Management

A surgical procedure is only carried out if all the previous treatment therapies have failed. In that case the swollen and thickened bursa and any bone spurs on the greater trochanter may be removed. Occasionally part of the gluteal tendons may be removed to decrease any possible friction caused on the greater trochanter.

How long does trochanteric bursitis last?

Prognosis is varied for trochanteric bursitis depending on the stage and severity of the irritation and inflammation. A minor irritation may take up to two weeks to resolve whilst a more serious irritation and inflammation may take between two and six months to resolve.

Can trochanteric bursitis be prevented?

Effective ways to prevent trochanteric bursitis are:

  • Correct postural problems that could be loading one hip joint more than the other.
  • Correct any leg length discrepancy.
  • Correct technique when performing sport exercises.
  • Avoidance of repetitive movements of the hip joint and sports that put the hip joint through high stress.
  • Maintain good stability and strength of the hip joint whilst stretching all the surrounding structures.
  • Use of good footwear and lose of excess weight.

What are the best exercises for trochanteric bursitis?

Exercises to help with the rehabilitation of trochanteric bursitis do not only focus on the hip joint itself but look at the broad kinematic chain of the low back, knee and ankle. By keeping these joints healthy and mobile there is less impact going through the hip joint, thus less strain and less chance of developing hip pain and irritation of the hip bursa.

Rehabilitation will focus on restoring good proprioception of the ankle, knee, hip and pelvis. Following that stretching of the primary hip muscles (TFL, iliopsoas, glutes) and secondary hip muscles (hamstrings, quadriceps, abductors and adductors) will restore the flexibility and mobility needed. Finally, strengthening all the above muscles including the trunk muscles (abdominals & back muscles) will help maintain a stable and strong joint.

People experiencing trochanteric bursitis often consult a doctor or physical therapist. With the right treatment management, a suitable training and rehabilitation plan for the individual and the relevant advice, patients can manage the symptoms and slowly return to their hobbies and activities.

Rehabilitation exercises:

Clamshell with band: lie on your side with the knees bent at 90 degrees and the hips at 60 degrees. Place a small elastic band just over your knees. Keeping your feet together brings your top knee up and away from your bottom knee against the resistance of the band. Repeat slowly for 12 repetitions and change sides.

Glute bridge with band: Lie flat on your back with your knees bent and your heels towards your buttock. Place a small elastic band over your knees. Whilst maintaining your back and feet on the floor push your pelvis up and squeeze your glutes. At the same time work against the elastic band by keeping your knees stable and away from each other. Repeat 10-12 times, rest for a few seconds and repeat for 2 more sets.

Step up stabilization: Stand parallel to a small step with one of your legs on it. Keeping your knee parallel to your toes slowly drop your pelvis and hanging leg to the floor and then slowly return to the starting position. Repeat very slowly for 10 times and then repeat on the opposite side.

Do I need to go to the GP or visit my local hospital?

Since trochanteric bursitis is a purely musculoskeletal injury you will most likely be referred to a manual therapist such as a physiotherapist or osteopath to aid in your treatment and recovery. However you should visit your GP if:

  • You have developed a fever or chills
  • The pain is excruciating and shooting towards the lower leg
  • You cannot move the affected joint.

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