Trochanteric bursitis
Encyclopedia
Greater trochanteric pain syndrome (GTPS), also known as trochanteric bursitis, is inflammation of the trochanteric bursa
, a part of the hip.
This bursa is situated adjacent to the femur, between the insertion of the gluteus medius and gluteus minimus muscles into the greater trochanter
of the femur
and the femoral shaft. It has the function, in common with other bursae, of working as a shock absorber and as a lubricant for the movement of the muscles adjacent to it.
Occasionally, this bursa can become inflamed and clinically painful and tender. This condition can be a manifestation of rheumatoid arthritis
or of an injury (often resulting from a twisting motion or from overuse), but sometimes arises for no obviously definable cause. The symptoms are pain in the hip region on walking, and tenderness over the upper part of the femur, which may result in the inability to lie in comfort on the affected side.
More often the lateral hip pain is caused by disease of the gluteal tendons which secondarily inflames the bursa. This is most common in middle-aged women and is associated with a chronic and debilitating pain which does not respond to conservative treatment. Other causes of trochanteric bursitis include uneven leg length, iliotibial band syndrome
, and weakness of the hip abductor muscles.
Greater trochanteric pain syndrome can remain incorrectly diagnosed for years, because it shares the same pattern of pain with many other musculoskeletal conditions. Thus people with this condition may be labeled malingerers, or may undergo many ineffective treatments due to misdiagnosis. It may also coexist with low back pain
, arthritis
, and obesity
.
Strength in the core and legs are also important to posture, so physical training also helps to prevent GTPS. But it is equally important to avoid exercises that damage the hip.
X-rays, ultrasound
and magnetic resonance imaging
may reveal tears or swelling. But often these imaging tests do not reveal any obvious abnormality in patients with documented GTPS.
or immobilizing the area but avoiding actions which result in aggravation of the pain. Icing the joint may help. A non-steroidal anti-inflammatory drug
may relieve pain and reduce the inflammation. If these are ineffective, the definitive treatment is steroid injection into the inflamed area.
Physical therapy to strengthen the hip muscles and stretch the iliotibial band can relieve tension in the hip and reduce friction. The use of ultrasound may be helpful.
In extreme cases, where the pain does not improve after physical therapy, cortisone
shots, and anti-inflammatory medication, the inflamed bursa can be removed surgically. The procedure is known as a bursectomy
. Tears in the muscles may also be repaired, and loose material from arthritic degeneration of the hip removed. (At the time of bursal surgery, a very close examination of the gluteal tendons will reveal sometime subtle and sometimes very obvious degeneration and detachment of the gluteal tendons. If this detachment is not repaired, removal of the bursa alone will make little or no difference to the symptoms.)
The bursa is not required, so the main potential complication is potential reaction to anaesthetic. The surgery can be performed arthroscopically and, consequently, on an outpatient basis. Patients often have to use crutches for a few days following surgery up to a few weeks for more involved procedures.
There are numerous case reports in which surgery has relieved GTPS, but its effectiveness is not documented in clinical trials.
Bursitis surgery at orthogate.com http://www.orthogate.org/patient-education/hip/trochanteric-bursitis-surgery.html
Bursa (anatomy)
A bursa is a small fluid-filled sac lined by synovial membrane with an inner capillary layer of slimy fluid . It provides a cushion between bones and tendons and/or muscles around a joint. This helps to reduce friction between the bones and allows free movement...
, a part of the hip.
This bursa is situated adjacent to the femur, between the insertion of the gluteus medius and gluteus minimus muscles into the greater trochanter
Greater trochanter
The greater trochanter of the femur is a large, irregular, quadrilateral eminence and a part of the skeletal system.It is directed a little lateralward and backward, and, in the adult, is about 1 cm lower than the head...
of the femur
Femur
The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
and the femoral shaft. It has the function, in common with other bursae, of working as a shock absorber and as a lubricant for the movement of the muscles adjacent to it.
Occasionally, this bursa can become inflamed and clinically painful and tender. This condition can be a manifestation of rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
or of an injury (often resulting from a twisting motion or from overuse), but sometimes arises for no obviously definable cause. The symptoms are pain in the hip region on walking, and tenderness over the upper part of the femur, which may result in the inability to lie in comfort on the affected side.
More often the lateral hip pain is caused by disease of the gluteal tendons which secondarily inflames the bursa. This is most common in middle-aged women and is associated with a chronic and debilitating pain which does not respond to conservative treatment. Other causes of trochanteric bursitis include uneven leg length, iliotibial band syndrome
Iliotibial band syndrome
Iliotibial band syndrome is a common injury to the thigh, generally associated with running, cycling, hiking or weight-lifting .- Definition :...
, and weakness of the hip abductor muscles.
Greater trochanteric pain syndrome can remain incorrectly diagnosed for years, because it shares the same pattern of pain with many other musculoskeletal conditions. Thus people with this condition may be labeled malingerers, or may undergo many ineffective treatments due to misdiagnosis. It may also coexist with low back pain
Low back pain
Low back pain or lumbago is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is...
, arthritis
Arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
, and obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
.
Prevention
Because wear on the hip joint traces to the structures that support it (the posture of the legs, and ultimately, the feet), proper fitting shoes with adequate support are important to preventing GTPS. For someone who has flat feet, wearing proper orthotic inserts and replacing them as often as recommended are also important preventive measures.Strength in the core and legs are also important to posture, so physical training also helps to prevent GTPS. But it is equally important to avoid exercises that damage the hip.
Diagnosis
A doctor may begin the diagnosis by asking the patient to stand on one leg and then the other, while observing the effect on the position of the hips. Palpating the hip and leg may reveal the location of the pain, and range-of-motion tests can help to identify its source.X-rays, ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
and magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
may reveal tears or swelling. But often these imaging tests do not reveal any obvious abnormality in patients with documented GTPS.
Treatment
The primary treatment is rest. This does not mean bed restBed rest
Bed rest is a medical treatment involving a period of consistent recumbence in bed. It is used as a treatment for an illness or medical condition, especially when prescribed or chosen rather than resulting from severe prostration or imminent death...
or immobilizing the area but avoiding actions which result in aggravation of the pain. Icing the joint may help. A non-steroidal anti-inflammatory drug
Non-steroidal anti-inflammatory drug
Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, but also referred to as nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal Anti-inflammatory medicines , are drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory...
may relieve pain and reduce the inflammation. If these are ineffective, the definitive treatment is steroid injection into the inflamed area.
Physical therapy to strengthen the hip muscles and stretch the iliotibial band can relieve tension in the hip and reduce friction. The use of ultrasound may be helpful.
In extreme cases, where the pain does not improve after physical therapy, cortisone
Cortisone
Cortisone is a steroid hormone. It is one of the main hormones released by the adrenal gland in response to stress. In chemical structure, it is a corticosteroid closely related to corticosterone. It is used to treat a variety of ailments and can be administered intravenously, orally,...
shots, and anti-inflammatory medication, the inflamed bursa can be removed surgically. The procedure is known as a bursectomy
Bursectomy
A bursa is a small sac filled with synovial fluid that cushions adjacent structures and reduces friction. Bursectomy refers to the removal of one of these structures, usually due to chronic inflammation or infection....
. Tears in the muscles may also be repaired, and loose material from arthritic degeneration of the hip removed. (At the time of bursal surgery, a very close examination of the gluteal tendons will reveal sometime subtle and sometimes very obvious degeneration and detachment of the gluteal tendons. If this detachment is not repaired, removal of the bursa alone will make little or no difference to the symptoms.)
The bursa is not required, so the main potential complication is potential reaction to anaesthetic. The surgery can be performed arthroscopically and, consequently, on an outpatient basis. Patients often have to use crutches for a few days following surgery up to a few weeks for more involved procedures.
There are numerous case reports in which surgery has relieved GTPS, but its effectiveness is not documented in clinical trials.
External links
Hip Bursitis at about.com http://orthopedics.about.com/cs/hipsurgery/a/hipbursitis.htmBursitis surgery at orthogate.com http://www.orthogate.org/patient-education/hip/trochanteric-bursitis-surgery.html