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Inflammation of the trochanteric bursa (on the left – in red, on the right – indicated by an arrow)
The muscles that provide movement in the hip joint contract and lengthen. In this case, the muscle can rub against surrounding muscles, tendons and bones. To reduce this friction in our body there are special synovial bags (bursae) that contain fluid. In some cases, the synovial bag becomes inflamed, which is manifested by pain. Such a disease is called bursitis (from the Latin word «bursa» – bag and ending «itis» – inflammation).
The main causes of bursitis are trauma, physical overload of tendons and muscles. The development of the disease is promoted by hypothermia, sedentary and inactive lifestyle, obesity, different leg lengths.
There are many synovial bags around the hip joint. The most common is trochanteric bursitis, which is sometimes called trochanteritis.
In case of a trochanteric bursa inflammation (trochanteric bursitis or trochanteritis), which is located near the greater trochanter of femur, pain is localized in the region of the greater trochanter – external bone protrusion on the femur. Next to this bursa, there is another one – an iliopsoas, but an iliopsoas bursitis does not have practical value since the treatment is the same in either case.
In this disease, there is a deep, sometimes burning pain in the hip joint, which sometimes radiates (gives) down along the outer surface of the thigh. A typical complaint is the inability to lie on a particular side due to a significant increase in pain in the thigh, as well as increased pain when walking, climbing stairs, squatting and rotating thigh inward, sometimes outward. The pain decrease at rest, but can periodically intensify at night, especially when lying on the sick side.
Upon examination, the doctor reveals pain during palpation (pressure) of the greater trochanter of the femur. A similar pain is present with tendinitis of the middle gluteal muscle, but it is felt slightly higher and is provoked by active abduction of the thigh, while pain with trochanteric bursitis is most felt in the position of pronation and adduction of thigh. To identify this symptom, the doctor moves a patient’s leg with his hands and determines the position in which pain is maximal.
Typical localization of pain in a patient with trochanteric bursitis
An X-ray examination for trochanteric bursitis can show calcifications (areas of ossification) in periarticular soft tissues near the greater trochanter. Also, osteophytes (bone spikes) can be detected in the region of the greater trochanter. Magnetic resonance imaging may show signs of inflammation of the trochanteric bursa and fluid accumulation in it. It is possible to perform an ultrasound, which also shows the presence of excess fluid in the bag.
For recovery, rest, physiotherapy exercises and anti-inflammatory drugs are usually enough. In protracted cases, physiotherapy, glucocorticoid injections, or surgical treatment may be required.
Injection of a hormonal drug into the trochanteric bursa area
Treatment begins with a prescription of anti-inflammatory drugs and elimination of movements that provoke pain. After stopping acute pain, stretching exercises should begin for stretching the iliotibial tract and tensor fasciae latae muscle, strengthening gluteal muscles. Specific exercises depend on the type of bursitis.
If these methods do not have the desired effect, physiotherapy, in particular electrophoresis or ultrasound therapy is prescribed. If this does not help, an injection of glucocorticoids in the most painful place is administered. In most cases, these methods are enough to cure the patient.
Extracorporeal shock wave therapy has a good effect.
In rare cases, pain persists despite conservative treatment and serves as an indication for surgery. Several methods of surgical treatment of trochanteric bursitis have been described, which, according to published data, are quite effective even among athletes and allow them to return to sports a few months after the operation.
The prognosis for recovery is usually good.