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Trochanteric Bursitis

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Introduction

Our hips are amazingly flexible and stable due to the way the joint and soft issues articulate. When we walk, they give us power and stability. When we jump, they can handle the impact. The hip joint is one of the largest and strongest joints in the human body. However, the hip can take a beating, and when that happens, we may feel pain – usually resulting from overload.

 

At Pure Physiotherapy, we often see people who have been diagnosed with ‘bursitis’ of the hip, which is an inflammation of the bursa. These fluid-filled sacs are found around the body and serve as cushions between bones and soft tissues such muscles, tendons, and skin. Each hip has two major bursae. The outside point of the hip – which is called the Greater Trochanter, has a bursa called the Trochanteric bursa (The other bursa – on the inside of the hip area, is called the Iliopsoas bursa).

 

When that bursa on the outside of the hip gets inflamed, you have trochanteric bursitis. This is also referred to as greater trochanteric pain syndrome (GTPS) which is a common condition and easily treatable.

Information Video

Signs & Symptoms

You’ll first notice Trochanteric bursitis when you feel pain at the outside of your hip. At first, the pain may be sharp, but with time, it may turn into a dull ache. Moving your hip, particularly going down stairs, might make the pain worse.

 

If left untreated, the pain may start going down your upper leg. You’ll likely feel it when you lay on the side of your affected hip and when getting up from a chair. The joint becomes stiff, and the bursa itself is sensitive to touch.

 

In extreme cases, your hip joint may become red and swollen and you may even have a fever. If you’ve had these symptoms for more than 3 weeks without improvement, you should discuss the symptoms with your Physio or GP.

Causes

You’ll find bursa sacs at many of the body’s major joints, including the elbow, shoulder, and knee. The small pouches are filled with a thick fluid and are meant to lubricate joints and protect body parts from friction.

 

The Trochanteric bursa, like other bursae, may become inflamed if the hip is overused or injured. Most issues causing bursitis are linked to poor hip strength and stability (lack of exercise) resulting in weak muscles which struggle to cope with the physical demands being forced on them in normal life – leading to excessive pressure on other soft tissues and inflammation.

 

Adults who rapidly increase their walking, running, or cycling may be susceptible to overloading the hip structures and triggering Trochanteric bursitis (but this is less common than the de-conditioning/lack of exercise trigger). The side of the leg includes a long piece of connective tissue called the Iliotibial band (ITB), which runs from the hip to the knee. If the ITB is tight from hard use, it may irritate the Trochanteric bursa leading to bursitis.

 

Other causes of Trochanteric bursitis include:

 

  • Muscle tears.
  • Hip injuries.
  • Hip surgery complications.
  • Poor posture.
  • Diseases such as gout (a form of arthritis with sudden, sharp attacks of pain, often at the base of the big toe).

Prevalence

Trochanteric bursitis is said to affect about five of every 1,000 adults and generally occurs in middle-aged or older people, though people of any age may get the condition.

Assessment & Diagnosis

A physical exam – including your clinician asking some specific questions, will help establish how long you’ve had the condition and identify specific movements that cause pain. In the vast majority of cases, a clear and accurate diagnosis can be made by taking a good history & thorough assessment, without the need for further investigation.

 

In rare cases, X-rays may be ordered to support differential diagnosis, as bursitis itself doesn’t show up on X-rays.

Trochanteric bursitis or Gluteal tendinopathy?

What is a Gluteal Tendinopathy?

Up until recently hip bursitis was diagnosed as the main cause of lateral hip pain but recent studies suggest that an irritation of the Gluteal muscle tendons are the most likely cause. The tendons attach onto a bony prominence (Greater Trochanter) where they can be subjected to compressive forces, leading to irritation. This can result in pain around the lateral hip, which can refer down the outside of the thigh and into the knee. Therefore, it’s important to recognise that an accurate diagnosis is important and informs the best treatment planning.

 

How common is Gluteal tendinopathy?

Gluteal tendinopathy is relatively common affecting 10-25% of the population. It is 3 times more prevalent in women than men and is most common in women between the ages of 40 and 60. One of the reasons for this is women tend to have a greater angle at their hip joint increasing compressive forces on the tendon. A good assessment by an experienced Physiotherapist will identify the diagnosis more accurately and ensure the right treatment for the right problem.

 

For more information on Gluteal Tendinopathy please click on the link

Self-Management

There is a lot you can do to help manage your symptoms and support your recovery at home. Your Physiotherapist will suggest:

 

  • Ice. Apply ice packs to your hip every 4 hours for 20 to 30 minutes at a time. Cold numbs the area, which can reduce pain and may cut down on swelling and inflammation.
  • Anti-inflammatory medications. Over-the-counter medications such as ibuprofen and prescription pain relievers can reduce pain and swelling. Be sure to check with a health care professional before taking them.
  • Rest. In very acute cases a short period of rest may be appropriate. However prolonged rest will often serve to worsen the underlying issues by weakening the hip muscles.

 

You can stop Trochanteric bursitis from becoming worse – or prevent ever developing it at all, if you take care of your hips (and the rest of your body) properly. Among the things you can do:

 

  • Exercise the right way. It’s great being active, but train properly. That means stretching, warming up, and listening to your body.
  • Strength training has been constantly show to help improve and prevent trochanteric bursitis, however gradually building up strength work is important as too much too soon is likely to flare symptoms. Take advice from an experienced Physiotherapist to guide you in this.
  • Weight loss if you’re overweight. It’s a sure way of taking pressure off your hips and knees. Your Physiotherapist will provide you with support and guidance for this.

Physiotherapy

Our expert Physiotherapists can give you exercises to improve flexibility and strengthen your muscles. We manage a large amount of people suffering with these issues on a daily basis. In the vast majority of cases the situation is relatively easy to address though Physiotherapy. You will be provided with a bespoke and progressive home exercise plan that will tailored towards helping you achieve the goals you will establish with your clinician.

Escalation of Treatment

Other treatments that are occasionally used might include:

 

  • Cortisone injection. Cortisone is a powerful anti-inflammatory medication. There is mixed evidence for their use in Trochanteric bursitis. Often there are short-term benefits in pain but if a program of strength/mobilization is not undertaken to address the underlying issues, pain often returns.
  • Low-energy shock wave therapy. Acoustic shock waves are passed through the skin with a targeted device. Again there is mixed research for this treatment and it should not be a first line treatment. However, some research shows that more than two-thirds of patients given shock wave therapy were greatly improved after 4 months in server/chronic cases.
  • Surgery. Though surgery is very rarely needed, the bursa can be removed if it is beyond repair. It’s usually an outpatient procedure, meaning no overnight hospital stay. A surgeon will use an Arthroscope (a special camera) and tiny instruments, as with common knee and elbow surgeries.
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