Trochanteric bursitis
Trochanteric bursitis is an inflammation of the fluid-filled sac (bursa) protecting the greater trochanter (the bony part of the hip). It is more common in women and older Australians, but can affect people at any age.
Causes of trochanteric bursitis
Trochanteric bursitis is most often caused by irritation of the bursa. This can be due to vigorous activity, injury, overuse, surgery, or excess body weight.
Incorrect posture or poor footwear can place abnormal stress on the hip joint and aggravate the bursa.
Other medical conditions, such as arthritis or gout, may exacerbate the condition. Patients with leg-length inequality or spinal disease tend to develop trochanteric bursitis at higher rates.
Symptoms of trochanteric bursitis
Trochanteric bursitis is characterised by pain in the trochanter (bony part of the hip), usually extending to the outside of the thigh area.
The pain is usually described as sharp and intense in the early stages, becoming more of an ache and spreading across a larger area of the hip over time. It may be accompanied by swelling, tenderness, and a limited range of motion in the affected hip joint.
This pain may worsen at night or when lying on the affected side. It may also worsen with prolonged activities, such as walking or climbing stairs. Many patients find that standing up after sitting for a long period can cause pain.
Some patients find that pain from the condition comes and goes over time, flaring up for a few days or weeks before settling down again.
Treatments for trochanteric bursitis
Activity modification is generally the first-line treatment for trochanteric bursitis. Your doctor may advise avoidance of activities which worsen symptoms, such as squatting, walking, or sitting for long periods. This may be paired with over-the-counter non-steroidal anti-inflammatory medications (NSAIDS) to reduce pain and inflammation.
Assistive devices – such as a cane or crutches – may be recommended for use during flare-ups. Used correctly, these can reduce stress on the hip joint and allow the bursa to heal.
Physiotherapy can strengthen the hip and increase its flexibility, reducing friction to the bursa. Dr Jonathan Cabot can recommend specific exercises for targeting the right muscle groups. You may be referred to a physiotherapist for ongoing treatment.
Trochanteric bursitis which doesn’t heal with rest and physiotherapy may be treated with corticosteroid injections. This involves a single injection of a steroid into the bursa. The injection may need to be repeated every few months for ongoing pain relief. Dr Jonathan Cabot can perform corticosteroid injections in his rooms without need for a hospital visit or this can be performed under ultrasound guidance by a radiologist.
Surgery
Surgery is rarely needed for trochanteric bursitis. It may be recommended in severe cases where the bursa does not respond to treatments, or if infection present. The bursa is not replaced and the hip can function normally without it.
Surgical removal of the trochanteric bursa can often be performed arthroscopically, creating minimal disruption to the surrounding tissue. Early indications have shown this approach to be very effective, although studies are still underway.