Greater Trochanteric Pain Syndrome (Trochanteric Bursitis):
What is Trochanteric Bursitis?
Trochanteric Bursa is a large slippery fluid-filled sac that separates the greater trochanter from the hip, muscles and tendons of the thigh and buttock. The greater trochanter is a bump located at the lateral upper part of the thigh. The function of the bursa is to cushion and lubricate the areas between the bones and tendons to prevent friction. One of the primary causes of hip pain is due to the inflammation and irritation of the bursa, also known as bursitis.
What symptoms should I experience?
The main symptom is sharp, intense pain located at the upper outer area of the hip. The area will be tender to palpation and will make it difficult to lie on the affected side, leading to difficult sleep. The pain will increase with activities such as walking or climbing stairs; it could radiate down the outside of the thigh to the knee area causing limpinig of the affected leg. In some cases, the pain is severe enough that would wake up patients at night.
What causes Trochanteric Bursitis?
The common causes for the development of trochanteric bursitis include:
How is Trochanteric Bursitis diagnosed?
The diagnosis of Trochanteric Bursitis is based on history of the pain and clinical evaluation. The patient will frequently notice the pain located in the outer hip with stair climbing or descending and when pressure is applied to the affected area. During the physical examination the physician will localize the tender area to be the trochanteric bursa. During the physical examination the physician will localize the tender area to be the trochanteric bursa. X-ray of the hip is commonly requested to rule out other conditions such as arthritis. On x-ray of the hip there might be calcification that will indicate a past history of inflammation of the bursa.
What are the treatment options for Trochanteric Bursitis?
The first line treatment for trochanteric bursitis include ice, anti-inflammatory medication, rest and physical therapy. Applying ica packs 20-30 minutes to the affected area every 4 hours will reduce the swelling and inflammation, which will decrease the pain. The over the counter anti-inflammatory medication such as ibuprofen (Advil, Motrin), acetaminophen (Tylenol), and naproxen (Aleve) will reduce the pain and inflammation. Physical therapy will provide exercises that will improve flexibility and strength to the muscles. Using a walker or crutches to take weight off and avoid pressure on the affected area will aid in a prompt recovery.
Once the first line treatment has failed, the physician will aspirate the bursa followed by a steroid injection (3:1 injection made of 3cc of lidocaine HCl 1% and 1cc of Triamcinolone Acetonide Suspension) targeted to the trochanteric bursa. On rare occasions, surgical drainage and removal of the affected bursa sac (bursectomy) if it is infected.
During the recovery process it is very important to modify the activities of daily living. For example, instead of running the patient should swim to reduce the pressure on the affected trochanteric bursa.
When can I resume activities of daily living?
Every patient will recover at a different rate. Therefore, to resume activities of daily living will be determined by how soon the affected hip and leg recover, not by how many days since the the symptoms or injury occured. Also, the longer the symptoms are present before the patient decides to be treated, the longer the recovery process.
How can I prevent Trochanteric Bursitis?
Most cases of trochanteric bursitis are caused by overuse. It is important to avoid the activities that will cause the irritation and inflammation to prevent pain. For example, avoiding repetitive activities that will apply increase stress to the hips. Maintaining strength and flexibility of the hip muscles will prevent trochanteric bursitis as well as hip injuries. Stretching the muscle on the outer side of the upper thigh is an excellent routine to prevent trochanteric bursitis.
