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Trochanteric Bursitis

Trochanteric bursitis, also known as greater trochanteric pain syndrome (GTPS), involves inflammation of the trochanteric bursa, a fluid-filled sac that cushions and protects the greater trochanter, the bony prominence on the outer side of the hip (femur). This condition also describes the associated overload of the gluteal (buttock) tendons where they attach at this bony prominence.

This condition can cause pain, tenderness, and stiffness in the hip, making it difficult to walk, climb stairs, or sleep on the affected side.

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Who is affected by trochanteric bursitis?

Trochanteric bursitis is most common in adults beyond the age of 40, particularly women. It is also more common in people who:

  • Participate in activities that involve repetitive hip movements, such as running, jumping, or lifting heavy objects

  • Have a history of hip injuries

  • Have osteoarthritis or rheumatoid arthritis

  • Have diabetes

  • Are overweight or obese

What are the main symptoms of trochanteric bursitis?

 

The main symptoms of trochanteric bursitis include:

Pain that is well localised to the outside of the hip, especially noted when lying on the affected side or when climbing stairs

Tenderness to touch over the greater trochanter

Stiffness in the hip, making it difficult to move the leg

A limp or antalgic gait

Symptoms may worsen during and after activity, and improve with relative rest.

How is trochanteric bursitis diagnosed?

Diagnosis of trochanteric bursitis is usually based on a physical examination and medical history review. Imaging tests, such as X-rays, ultrasound or MRIs, may be used to rule out other causes of hip pain, such as arthritis or fractures. On ultrasound assessment the doctor will be looking for fluid in the trochanteric bursa, bony irregularity of the greater trochanter, thickening and tendinopathy in the gluteal (buttock muscle) tendons and tenderness in the region with ultrasound probe pressure.

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How is trochanteric bursitis treated?

 

Treatment for trochanteric bursitis focuses on reducing inflammation, alleviating pain, and restoring range of motion in the hip, as well as strengthening of the gluteal muscles. Non-surgical treatments are usually effective and may include:

  • Rest:

    Avoiding activities that aggravate the pain.
  • Ice application:

    Applying ice packs to the affected area for 10-15 minutes at a time, several times a day, can help reduce inflammation and pain.
  • Over-the-counter pain relievers:

    Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help alleviate mild to moderate pain and inflammation.
  • Physiotherapy:

    Physiotherapy can provide exercises and stretches to improve range of motion, strengthen the muscles around the hip, and promote normal hip movement patterns.
  • Lifestyle modifications:

    Losing weight, if overweight or obese, can help reduce strain on the hip joint and gluteal muscles.
  • Corticosteroid injections:

    In some cases, corticosteroid injections into the trochanteric bursa can provide temporary pain relief and reduce inflammation.

At The Joint Injection Clinic, corticosteroid injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor.  The experienced medical doctor will then place you in a side-lying position on the bed with the affected hip facing upwards.  The skin is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  Local anaesthetic is sometimes injected from the skin to the bursa under ultrasound guidance.  After giving the local anaesthetic a few minutes to take effect, the bursa injection is performed with a small dose of steroid and local anaesthetic, targeting the bursa, superficial to the gluteal tendon insertion.

The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given.  The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

If non-surgical treatments fail to provide adequate relief, surgery may be considered, although is very rarely used. Surgical intervention for trochanteric bursitis involves releasing or removing the inflamed bursa. This procedure is typically performed minimally invasively under local anaesthesia.

Additional tips for managing trochanteric bursitis pain:

  • Avoid activities that aggravate the pain, such as running or jumping.
  • Maintain a healthy weight to reduce stress on the hip joint.
  • Use a pillow between your knees when sleeping on your side.

If you are experiencing pain, tenderness, or stiffness in your hip, it is important to see a doctor to get a diagnosis and discuss treatment options. With early diagnosis and treatment, most people with trochanteric bursitis can recover fully and return to their normal activities.