Trochanteric Bursitis

Trochanteric bursitis can result from a single or multiple amount of causes, including the following:

• Injury to the hip – This may include falling onto the hip, bumping the hip into a hard object, or simply lying on one side of the body for a long period of time.

• Incorrect posture – This can be associated with other conditions such as scoliosis, arthritis of the lumbar spine, and other spine problems.

• Overuse/injury to the joint areas – Activities that might include running up the stairs, climbing, or standing for an extended period of time.

• Stress on the soft tissues – This can result from an abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a joint).

• Other complications – These may include rheumatoid arthritis, gout, thyroid disease, psoriasis, or an unusual drug reaction. In some rare cases, bursitis can result from an infection.

• Past surgical procedures – around the hip or prosthetic implants in the hip.

Other causes of trochanteric bursitis include:

• Trauma – A patient who suddenly falls on the outside of his / her hip, or banging the hip on any hard surface, can cause the bursa to fill with blood and / or its lining to become inflamed. Even though the blood may be reabsorbed into the body, the bursa lining may stay inflamed, causing hip bursitis symptoms. This condition is termed traumatic hip bursitis.

• Repetitive pressure or friction – Trochanteric bursitis can be caused by repetitive mini-traumas to the bursa. These mini-traumas can cause the same problems as a single, more serious trauma. For instance, people who bike or run regularly may be more prone to hip bursitis.

• Bone spurs or calcium deposits – Hip bursae and other soft tissue can become irritated by bone spurs, also called ‘osteophytes’, and calcium deposits, which are small collections of calcium that are often small and soft but can grow and harden over time.

Symptoms include joint pain and tenderness. You may also experience swelling and feel warmth around the affected area. The pain is often sharp in the first few days. It may be dull or even achy later. You may also notice it more when getting out of a chair or bed, sitting for a long time, and when sleeping on the affected side.

Acute trochanteric bursitis normally flares over hours or days. However, chronic trochanteric bursitis can last from a few days to several weeks. Chronic bursitis can go away and come back again sooner. Acute bursitis can become chronic if it returns or if a hip injury occurs.

The underlying causes of trochanteric bursitis vary widely, ranging from an obvious trauma to a systemic disease such as gout. In addition, some patients are at a higher risk for this condition due to their anatomy.

The most common risk factors for trochanteric bursitis include:

• Obesity – Being overweight can affect gait and put excess strain on the hip joint, increasing the risk for trochanteric bursitis.

• Age and gender – Women are more likely to report pain at the side of the hip than men. Although people of any age can be affected, patients in their 40s, 50s, and 60s are more prone to develop trochanteric bursitis.

• History of inflammation of the bursa – Patients who have had bursitis in the past are more likely than others to get it again. When bursitis persists or re-occurs, it is then turned into chronic bursitis.

Certain complications of trochanteric bursitis can include:

• Continuing the pain that interferes with your daily activities.

• Loss of movement in your hip where it is affected.

• A disability may occur if your affected hip is left untreated due to trochanteric bursitis.

Additionally, an untreated condition of hip bursitis will eventually lead to a chronic position through the build-up of calcium in soft tissues, which could result in a permanent loss of movement of that area.

Trochanteric bursitis symptoms can be mistaken for symptoms of other conditions. To help diagnose trochanteric bursitis, a doctor must rule out other problems that could cause outer hip pain, such as hip osteoarthritis, tendonitis, snapping hip syndrome, iliotibial band syndrome, and other conditions affecting the low back.

Therefore, a physician or other licensed medical care provider may conduct the following:

• Interview with the patient – A doctor will ask a patient about medical history and to describe the onset of his / her symptoms, the pattern of pain and other symptoms, as well as how symptoms are affecting lifestyle.

• Physical exam – The doctor will then examine the patient’s joint, noting swelling, tenderness, and pain points. Afterwards, the doctor will also use a series of physical tests, such as asking the patient to move the leg out and away from the body (abduction) and in and across the body’s midline (adduction).

If it is unclear whether symptoms are caused by trochanteric bursitis or another condition, a doctor may request the following:

• X-ray – One of the most common types of medical imaging ordered is X-ray – X-rays can help determine if a stress fracture or osteoarthritis is at the root of the general hip pain.

• Magnetic resonance imaging (MRI) – An MRI isn’t necessary to diagnose trochanteric bursitis, however, it may be ordered to confirm or rule out possible diagnoses. An MRI will provide a detailed view of the soft tissue and detect abnormalities such as a swollen bursa or damaged tendon.

• Ultrasound – Similar to an MRI, ultrasound is also not necessary to diagnose this condition. An ultrasound can detect areas of fluid, such as the excess synovial fluid found in a swollen bursa.

Avoiding the activity that caused trochanteric bursitis will give your hip time to heal. You can also try one of these medical treatments to bring down inflammation and relieve pain:

• Steroid injections – your doctor may give you injections of corticosteroid medicine to bring down inflammation and manage pain.

• Non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen (Motrin, Advil), and naproxen (Naprosyn) can help control inflammation and pain. Because NSAIDs can cause side effects like stomach pain and bleeding, it is recommended to use them for the shortest possible amount of time needed.

• Supportive devices – use a cane or crutches to take the weight off your hip while you are recovering.

A physiotherapist will work together to develop a plan to help achieve your specific goals and get you near to recovering completely. To do so, your physiotherapist will select a variety of treatment strategies in any or all of the following areas:

Patient education

Your physiotherapist will first work with you to identify and change any factors causing your pain, such as the type and amount of exercises you perform, your athletic activities, or your footwear. Next, your therapist will recommend improvements throughout your daily activities, and create a personalized exercise program to help ensure a pain-free return to your desired activity level.

Managing pain

Your physiotherapist will design a program to address your pain that includes applying ice to the affected area as well as an application of heat, such as a hot shower or heating pad. Your therapist may also recommend decreasing some activities that cause further pain. Physiotherapists are experts in prescribing pain-management techniques that reduce or eliminate the need for medication.

Range of motion exercises

Your low back, hip, or knee joint may be moving improperly, causing increased tension at the greater trochanter. Therefore, your physiotherapist may teach you self-stretching techniques to help decrease tension and help restore normal motion in the back, hip, and knee.

Manual therapy

Your therapist may apply hands-on treatment to gently move your muscles and joints, most likely your lower back, hip, or thigh in the case of trochanteric bursitis. These techniques help improve motion and strength and often address areas that are difficult to treat on your own.

Muscle strength

Muscle weaknesses or imbalances can result in the excessive strain at the greater trochanter. Based on your condition, your physiotherapist will design a safe, individualized, progressive resistance program, including your core and lower extremity. You may start by performing strengthening exercises lying on a table or at home on the bed or floor. You then advance to exercises in a standing position such as standing squats. Finally, your physiotherapist will choose what exercises are right for you based on your age and physical condition.

Functional training

Once your pain, strength, and motion improves, you can safely transition back into more demanding activities. To help minimize the tension on the hip and your risk of repeated injury, it is important to teach your body safe, controlled movements. Based on your own unique movement assessment, your therapist will create a series of activities to help you learn how to use and move your body correctly and safely.

If pain relievers, physiotherapy, or other non-invasive treatments do not work for you, your doctor might recommend surgery to remove the affected bursa. This procedure can be done laparoscopically, through very small incisions using a camera to guide the surgeon. However, recovery may take a few days.

Doing exercises to strengthen your thighs can help stabilize your hip joint and protect it from injury. Here are some exercise examples you can try to reduce symptoms linked to trochanteric bursitis:

• Lying lateral leg raise – First, lie on your right side. Next, extend your right arm out for balance. Lift your left leg as far as you can, then bring it down. Repeat this exercise 4 sets of 15 repetitions on each leg.

• Lying leg circles – Lie flat on your back with your legs extended. Afterwards, raise your left leg about 3 inches off the ground and make small circles with it. Perform this exercise with 3 sets of 5 rotations on each leg.

• Hip bridges – Lie on your back with your feet flat on the ground and your knees bent. Next, raise your hips until they line up with your shoulders and knees. Lastly, slowly lower your hips to the ground, then repeat this with 5 sets of 20 repetitions.

The initial treatment of trochanteric bursitis includes rest, activity changes, ice application, and weight loss, such as the following:

• Rest and activity changes – When trochanteric bursitis stems from injury or overuse, rest and other remedies to relieve inflammation are normally successful. Patients with trochanteric bursitis should avoid activities that will aggravate and inflame the bursa, which may include sports and / or standing for long periods of time.

• Ice application – Applying ice or a cold pack to the sore hip can help reduce local pain and swelling. This treatment is highly recommended after any exercise or activity that may inflame the hip bursa.

• Weight loss – If excess weight is a possible underlying cause of trochanteric bursitis, then losing weight can be part of a successful treatment plan.