What is trochanteric bursitis?
A bursa is a type of musculoskeletal cushion and its primary function is to allow smooth gliding of tissues over what is often a bony prominence. In the case of the hip, the most common type of bursitis is trochanteric bursitis. Other types of bursitis include ischial bursitis which involves the bony prominence of the pelvis upon which one sits. There can also be iliopsoas bursitis which often causes a deep groin pain and is not so much secondary to a bony prominence but instead is often caused by the socket component of a total hip replacement.
What can cause it?
Trochanteric bursitis is known as an overuse syndrome and therefore can be caused by excessive use of the hip. Other causes include iliotibial band friction syndrome where the tight band of tissue over the bursa actually compresses it against the bony prominence. It can also be secondary to a previous total hip replacement. As the gluteus medius tendon inserts into the greater trochanter, a tendonitis of the insertional fibres can also mimic symptoms of trochanteric bursitis. Often the two co-exist, ie gluteus medius tendinitis/tendinopathy along with trochanteric bursitis.
What are the symptoms and signs?
The symptoms of trochanteric bursitis comprise a pain situated on the outer aspect of the hip, just over the bony prominence. This pain can be activity related and the classic complaint is that of pain over the affected site as one turns in bed at night time.
Can the problem get worse?
The natural history of this condition, with or without a co-existing gluteus medius tendinopathy, can be phenomenally difficult to predict. There is a broad spectrum of progression consisting at one end of those patients who experience intermittent symptoms which spontaneously resolve, through to those patients who experience significant recalcitrant symptoms.
What investigations may be required?
The diagnosis here is primarily clinical. However, an ultrasound scan or an MRI scan of the pelvis may be required in most cases to exclude any other causes of pain. If a significant spinogenic component is suspected, one would also consider performing an MRI scan of the lumbar spine.
As mentioned, regardless of which treatment options one pursues, this condition is associated with a significant recurrence rate. Only in complex, stubborn, recalcitrant cases would one consider performing a surgical decompression of the bursa along with needling of the gluteus medius tendinous insertion.
Often an ultrasound-guided steroid injection can significantly alleviate the symptoms. Normally, three, staggered, sequential injections are performed to switch off the noxious stimulus. There is also some evidence which supports the use of autologous platelet-rich plasma injections which are also performed under ultrasound guidance.
Following a careful assessment, if there is a significant gluteus medius tendinopathic component then eccentric stretches by an experienced physiotherapist may help to eliminate the symptoms. Sometimes it may prove to be of benefit to also consult a pain specialist, especially in recalcitrant cases that have not responded to therapy.