What is Trochanteric Bursitis?
Trochanteric bursitis is inflammation of the bursa (ie. a fluid filled sac that overlies joints or bony prominences) at the outermost (ie. lateral) point of the hip known as the greater trochanter. When this bursa becomes inflamed or irritated, it causes pain on the side of the hip. It is a common cause of hip pain also known as greater trochanteric pain syndrome.
What are the Symptoms of Trochanteric Bursitis?
Trochanteric bursitis typically causes the following symptoms:
- Pain on the outside of the hip and thigh or in the buttock.
- Pain when lying on the affected side.
- Pain when you press in on the outside of the hip.
- Pain that gets worse during activities such as getting up from a deep chair or getting out of a car.
- Pain with walking up stairs.
How is Trochanteric Bursitis Diagnosed?
A well trained doctor or other para-medical professional will suspect trochanteric bursitis based on your symptoms and a thorough examination of your hip. The diagnosis will often be confirmed by additional tests such as ultrasounds and MRIs. Not all of these tests are required to confirm the diagnosis.
MRIs are helpful in visualising the soft tissues around the hip. It is also useful for visualising associated gluteal tendon tears or tendinopathy (ie. inflamed tendons) adjacent to the bursa.
What are the Causes of Trochanteric Bursitis?
Trochanteric bursitis may result from one or more of the following events:
- Injury to the point of the hip.
This can include falling onto the hip, bumping the hip into an object, or lying on one side of the body for an extended period.
- Play or work activities that cause overuse or injury to the joint area.
Such activities might include running up stairs, climbing, or standing for long periods of time.
- Incorrect posture.
This condition may be caused by scoliosis, arthritis of the lumbar spine, and other spinal problems.
- Stress on the soft tissues.
This may be a result of an abnormal or poorly positioned joint or bone (such as leg length discrepancies or arthritis in a joint).
- Other diseases or conditions.
These may include rheumatoid arthritis, gout, psoriasis, thyroid disease or an unusual drug reaction. In rare cases, bursitis may result from infection.
- Previous surgery around the hip or prosthetic implants in the hip.
- Hip bone spurs or calcium deposits in the tendons that attach to the trochanter.
Bursitis is more common in women and in middle-aged or elderly people. Beyond the situations mentioned above, in many cases, the cause of trochanteric bursitis is unknown.
Is Trochanteric Bursitis Dangerous?
Trochanteric bursitis is not life threatening but it can severely impact your quality of life and function. Most cases of bursitis improve without any treatment over a few weeks. See your health care provider if you have any of the following signs or symptoms:
- You experience pain that interferes with your normal day-to-day activities or have soreness that does not improve despite self-care measures.
- You have recurrence of bursitis.
- You have a fever or the area affected appears red, swollen or warm.
It is important to see your doctor if you have other medical conditions that may increase your risk of an infection, or if you take medications that increase your risk of infection, such as corticosteroids or immunosuppressants.
How do you prevent trochanteric bursitis?
As most cases of bursitis are the result of overuse, the best treatment is prevention. It is important to avoid or modify the activities that cause the problem. Underlying conditions such as leg length differences, improper posture, or poor technique in sports or work must be corrected.
Apply these basic rules when performing activities:
- Take it slow at first and gradually increase your activity level.
- Use limited force and limited repetitions.
- Stop if unusual pain occurs.
- Avoid repetitive activities that put stress on the hips.
- Lose weight if you need to.
- Get a properly fitting shoe insert for leg length differences.
- Maintain strength and flexibility of the hip muscles.
- Use a walking cane or crutches for a week or more when needed.
What is the Treatment for Trochanteric Bursitis?
Treatment goals include reducing pain and inflammation, preserving mobility, and preventing disability and recurrence.
Treatment recommendations may include a combination of rest, splints, heat, and cold application. More advanced treatment options include:
- Non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen.
- Corticosteroid injections or PRP (protein rich plasma) injections given by your health care provider. Injections work quickly to decrease the inflammation and pain.
- Physical therapy that includes range of motion exercises and splinting. This can be very beneficial.
- Surgery, when other treatments are not effective.
Recalcitrant trochanteric bursitis can be treated with arthroscopic bursectomy and ITB release. Occasionally, a formal abductor repair may be required if a tear is present.
When can I walk after surgery?
Full weight-bearing and walking is allowed immediately. Initially, this will be aided by crutches. Most people will walk independently by 10-14 days post-operatively.
When can I drive?
You should not drive for 48 hours after an anaesthetic. After 48 hours, your ability to drive will depend on the side you had your operation, left or right, and the type of vehicle you drive, manual or automatic. If you had a left hip procedure and drive an automatic, you can drive whenever you feel comfortable. Otherwise, it is reasonable to drive when you are confident with walking and can fully weight-bear on your affected side.
When can I work?
Your return to work will vary depending on the procedure performed and type of work you are engaged in. Most people can return to office work within 2-4 weeks. Labour intensive work however, may require you to take 4-6 weeks before returning to full duties.
When can I play?
Low impact activities, such as cycling and swimming, can be commenced from week 6. High impact activities such as running are best avoided for 10-12 weeks after surgery.
How long will it take to heal?
The wounds take 7-10 days to heal. Most patients improve dramatically in the first 6 weeks. Occasionally, there are periods where the hip may become sore and then settle again. This is part of the normal healing process. It takes three months for your hip to fully recover from a hip procedure. Continued improvements may be gained up to 1 year post-surgery.
How much pain will I experience?
Local anaesthetic is injected around the wound during the procedure and most patients are pleasantly surprised at how little pain they have after the procedure.
What are the risks of surgery?
Complications are not common but can occur. Prior to making any decision to have surgery, it is important that you understand the potential risks so that you can make an informed decision on the advantages and disadvantages of surgery. The following list is by no means exhaustive, so it is important to discuss your concerns with your your surgeon.
Some patients occasionally report numbness or tingling in the groin or inner thigh. This usually resolves with time. It is quite normal to experience some swelling and discomfort in the leg, thigh and buttock region. This is expected and will also resolve with time.
Other general surgical risks include: risk of infection, bleeding and clots in the leg (DVT) or lung post-operatively.
Apart from surgical risks, medical (including allergies) and anaesthetic complications can occur, and these can affect your general well being and health.
- Femoroacetabular Impingement
- Cam Impingement
- Pincer Impingement
- Labral Tears
- Ligamentum Teres Tear
- Trochanteric Bursitis
- Psoas Tendinopathy
- Muscle Strain
- Hip Bursitis
- Hip Avascular Necrosis
- Hip Fracture
- Hip Dislocation
- Gluteus Medius Tear
- Hip Labral Tear
- Chondral Lesions
- Hip Instability
- Loose Bodies
- Hip Osteoarthritis
- Inflammatory Arthritis of the Hip
- Childhood Hip Problems