Trochanteric Bursitis
What is trochanteric bursitis?
Trochanteric bursitis is inflammation of a lubricating membrane (bursa) located on the side of the hip. The condition is commonly associated with inflammation & weakness of the tendons attaching at the side of the hip and pelvis region (gluteal tendinopathy). Often the terms "Trochanteric Bursitis" and "Gluteal Tendinopathy" are used interchangably as most people have elements of both conditions.
While some conditions may predispose to the development of trochanteric bursitis (rheumatoid arthritis, hip joint disorders, tight iliotibial band), most people who develop trochanteric bursitis have no clear precipitating factor apart from deconditioning of the deep "core" postural muscles surrounding the joint. A very significant factor influencing the generation of gluteal tendinitis or trochanteric bursitis in the majority of people relates to factors such as posture, habit and physical conditioning that can be treated by physical therapy and activity modification.
Trochanteric bursitis can effect people of all ages and activity levels but is more common in middle aged females. Occasionally the condition is observed in association with trauma or surgery around the hip region. In association with trochanteric bursitis, some people may develop degenerative changes or a tear in the adjacent supportive hip tendons.
What are the symptoms of trochanteric bursitis?
Trochanteric bursitis typically causes pain distributed to the outer hip region. The pain is often made worse by long walks, stair climbing or prolonged standing. Lying on the effected side often produces discomfort at night. Many people also have weakness of the muscles about the hip, resulting in a limp after long walks or making them feel unstaedy when standing on one leg. Most patients with trochanteric bursitis do not recall a specific accident or event to cause their symptoms but rather a gradual onset of increasing discomfort over many weeks or months which fluctuates with activity levels. The pain can sometimes be quite severe and disabling. The condition tends to be chronic in nature (spanning many months or years) and has a high recurrence rate, particularly in women.
How is trochanteric bursitis treated?
The mainstay of treatment is effective and sustained physical therapy and conditioning for improving the functional strength and endurance of the supporting muscles around the hip joint. Muscle conditioning and education is critical for this condition - the recurrence of bursitis pain is common in people who have not obtained satisfactory muscle function with their physical therapy efforts. Tablets and injections for bursitis are used only to assist with physiotherapy efforts - a short course of anti-inflammatory tablets and intermittent cortico-steroid injections can be used to provide temporary relief while physiotherapy progresses. Other types of injectable therapies have been described (for example PRP - platelet rich plasma) and are generally reserved for patients who fail to settle with standard tharapies. Non operative treatments are effective for the majority of patients with trochanteric bursitis, however the recovery is often slow, taking a number of months. Patience and persistence is required.
What operations can be used to help?
Surgery is usually only considered after other treatments have been conducted properly. Surgery is a safe method of treating trochanteric bursitis and in most cases can be undertaken arthoscopically (key hole surgery). Surgery however is not effective in all people. The tight band of tissue on the side of the hip (iliotibial band) is decompressed and the inflammed bursa removed. Where necessary, repair of a torn or degenerate abductor tendon may also be conducted. As the surgery is often performed by arthroscopic methods, recovery is relatively quick and only an overnight hospital stay is required, however sustained physiotherapy afterwards is still required to achieve good results.
Related publications
Weinrauch P, Kermeci S. (2013) Ultrasound assisted arthroscopic proximal iliotibial band release and trochanteric bursectomy. Arthroscopy Techniques. 2(4): 433 – 435. Link
This information has been written by A/Prof Patrick Weinrauch for the purposes of patient education. The details provided are of general nature only and do not substitute for professional recommendations based an individual clinical assessment.
