Hip
Trochanteric Bursitis
What is trochanteric bursitis?
Trochanteric bursitis is a medical condition characterized by inflammation of the trochanteric bursa, which is a small, fluid-filled sac located around a part of the hip joint known as the greater trochanter. This bursa serves as a cushion or lubricating sac that reduces friction between the bones, tendons, and muscles in the hip area. When it becomes inflamed, typically due to repetitive stress, overuse, or trauma, it can cause pain and discomfort in the outer, or lateral, hip region.
What causes trochanteric bursitis?
Trochanteric bursitis is more common in women and in middle-aged people, although anyone can experience it. In many cases, the cause of trochanteric bursitis is unknown. However, trochanteric bursitis can be caused by the following:
- Injury to the hip joint: A fall, bumping into things, or lying on one side of the body for extended periods of time.
- Repetitive stress to the hip joint: Repetitive climbing, cycling, running, climbing stairs, or standing for extended periods of time.
- Spine-related issues: Scoliosis and lumbar/lower spine arthritis are commonly associated with trochanteric bursitis.
- Stress on nearby soft tissue: such as due to leg-length differences leading to poor joint positioning.
- Other medical conditions: Rheumatoid arthritis, gout, psoriasis, thyroid disease, drug reactions, or even infections.
- Previous surgery around the hip joint.
- Extra bony growths or mineral deposits in ligaments near the greater trochanter.
What are the symptoms of trochanteric bursitis?
The main symptom of trochanteric bursitis is pain near the lateral aspect of the hip joint (on the side of the hip), in your outer thigh or in your buttocks. Initially, this pain is described as “sharp” or “intense;” later, the pain becomes “achy” and can spread to other areas near the hip. Other symptoms can include:
- Pain that is worse at night
- Pain when lying on the affected side.
- Pain when you push on the outside portion of the hip joint.
- Pain that worsens when you get up from a seated position like from a car or chair.
- Pain when walking upstairs.
- Pain that worsens with activities such as walking, climbing stairs, or lying on the affected side
How is trochanteric bursitis diagnosed?
During your consultation with Dr. Bryan Penalosa, a Chicago sports medicine surgeon and hip specialist, your medical history, greater trochanteric bursitis symptoms, and past injuries will be reviewed.
Physical Exam
He will conduct a physical examination checking range of motion, strength, and palpation of the painful hip region. Palpation may include Dr. Penalosa or a member of his team gently pressing on the affected area to check for tenderness, swelling, or warmth. This can help identify the specific location of pain and rule out other possible causes. A comprehensive physical exam is key to determine the cause of your hip pain.
Imaging
In some cases, imaging studies may be ordered to confirm the diagnosis of trochanteric bursitis and rule out other conditions that could be causing the lateral hip pain. X-rays are often the first imaging test done to rule out issues such as fractures or degenerative joint diseases. While they may not directly show bursitis, they can help rule out other causes of hip pain. Ultrasound imaging can provide real-time images of soft tissues like the bursa and can help identify signs of hip inflammation or fluid accumulation in the trochanteric bursa. An MRI may be recommended to gain detailed images of the hip area, including the bursa, gluteal tendons, hip labrum, and muscles.
Hip Injection
A greater trochanteric bursa hip injection can help confirm the diagnosis of trochanteric bursitis. This injection will be performed in the office at the time of your visit under ultrasound guidance. If the majority of your pain goes away, even temporarily, following the injection, it confirms that the source of the pain is due to trochanteric bursitis.
Trochanteric Bursitis Treatment Options
Can trochanteric bursitis be treated without surgery?
The initial treatment for trochanteric bursitis does not involve surgery. Many individuals find relief with lifestyle modifications, including:
- Avoiding activities that worsen symptoms.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and celecoxib, help reduce hip pain and hip inflammation.
- Using a cane or crutches to help with walking.
- Physical therapy to increase hip strength and flexibility. This can include stretching the hip joint, rolling therapy, and/or learning to use ice or heat to relieve pain.
- Injection to the greater trochanteric bursa may help with pain relief temporarily (months) or permanently. This involves injecting either a corticosteroid (a type of medication that helps reduce hip inflammation) or platelet rich plasma (PRP) to the lateral hip and affected bursa.
What are the surgical options for trochanteric bursitis?
Although rare, when nonsurgical trochanteric bursitis treatments do not relieve hip pain and hip inflammation, hip surgery is a reasonable option. Surgery would include either an open or arthroscopic greater trochanteric bursectomy. This is an outpatient procedure, and patients typically go home the same day of surgery. A greater trochanteric bursectomy does not affect the hip joint, and the hip can function without this bursa normally.
How long is the recovery after a greater trochanteric bursectomy?
The recovery time after trochanteric bursitis surgery can vary depending on several factors, including the extent of the surgery, individual patient characteristics, and the level of activity that the patient is striving to return to. So long as the surgery does not entail work on the gluteal tendons or hip labrum, then you will be able to put weight on the operative leg immediately following surgery depending on your pain. In general, most patients can recover full, unrestricted activity in 2-4 months following greater trochanteric bursectomy so long as they complete a good physical therapy program.
Long-Term Effects of Untreated Trochanteric Bursitis
What are the long-term effects of untreated trochanteric bursitis?
The main issue with untreated trochanteric bursitis is that it can sometimes progress to tearing of the tendons around the bursa. Those tendons, called the gluteus medius and gluteus minimus tendons, are known as the rotator cuff of the hip. With constant inflammation, these gluteal tendons can sometimes suffer and begin to tear.
It’s important to note that not everyone with untreated trochanteric bursitis will progress to injury of the gluteal tendons, and the rate of progression can vary widely among individuals. However, addressing trochanteric bursitis early through conservative treatments or surgical intervention can help reduce the risk of these long-term complications and improve hip joint function and overall quality of life.
How is trochanteric bursitis prevented?
Although trochanteric bursitis cannot always be prevented, there are some things you can do to prevent the inflammation and pain from getting worse. These include avoiding activities that put additional stress on the hips, losing weight if appropriate, and maintaining hip strength and flexibility. It’s also important to correct underlying hip conditions such as leg-length differences and poor posture.