Trochanteric Bursitis of the Hip

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Introduction

Welcome to the patient resource regarding Trochanteric Bursitis of the Hip created by Hicksville Physical Therapy.


While bursitis can impact various joints, the hip is a common place for this condition to occur. In the hip, a large tendon passes over the greater trochanter, a bony bump located on the side of the hip. Trochanteric bursisis refers to inflammation within the bursa located between the greater trochanter and the tendon. This condition is most often found in older patients. Younger individuals who maintain an extremely active lifestyle may also develop this condition.

In this guide, you will learn:

  • How trochanteric bursitis develops
  • How doctors can diagnose trochanteric bursitis
  • What treatments are available for this condition

Anatomy

Where is the trochanteric bursa, and what does it do?

One of the body’s most important ball-and-socket joints is the hip joint. The acetabulum, also known as the hip socket, forms a deep cup that encapsulates the femoral head, which is the ball located in the upper thigh bone (or femur). The hip is surrounded by thick muscles of the buttock located at the back, as well as the muscles of the front thigh.

The sizable bump on the upper end of the femur is the greater trochanter. Here, the large buttock muscles and the femur connect, allowing the hip to move. The gluteus maximus, the biggest of these muscles, is attached on the lower portion of the femur.

In areas where friction results between bones, tendons, and muscles, you will typically find a structure called a bursa. A bursa is a fine tissue sac filled with fluid that is used to reduce friction in the area. The bursa is normal and can often be produced by the body as a response to friction.

Related Document: A Guide to Hip Anatomy

Causes

Why do I have this problem?

Sometimes, as a result of injury to the bursa or excessive friction in the area, a bursa may become inflamed (irritated and swollen). An inflamed bursa can be painful, as structures near the bursa can rub against it as the body moves.

Friction may build up within the bursa during walking if there is tightness in the lengthy tendon located on the thigh’s side. Experts are not sure what causes this tightening.

This long tendon is attached to the gluteus maximus. With every step, the gluteus maximum pulls the long tendon over the greater trochanter. The tendon will rub against the bursa when it is tight.

Because of the rubbing, friction builds inside the bursa, which can result in inflammation and irritation. Friction may also result if the gluteus medius, the outer hip muscle, is weak, if you run on slanted surfaces, or if one leg is lengthier than its counterpart.

 

Animation of rubbing on the bursa

Often, trochanteric bursitis can arise over time with no apparent cause or signs of injury. The condition may result after various types of hip surgery, such as hip replacement. The cause may also stem from an amalgamation of changes in the way the hip works and is aligned, or it may be impacted by the way that scar tissue forms from the incision as it heals.

A hematoma can form if a fall on the hip results in bleeding into the bursa. While the bleeding is not serious, the bursa may become inflamed as a reaction to the blood. Because of this inflammation, the bursa will likely become thickened over time. As a result of the thickening, along with repeating inflammation and irritation, the condition may become chronic (long-lasting).

Symptoms

What does the condition feel like?

Typically, pain is the first symptom of trochanteric bursitis. Pain can be experienced in the hip just above the bump that makes up the greater trochanter. Over time, this pain may travel down the thigh’s outer portion. As the condition worsens, symptoms may lead to a limp when walking, as well as stiffness of the hip joint. Eventually, pain may not cease with rest and could impact sleeping habits.

Diagnosis

The team at Hicksville Physical Therapy begins a trochanteric bursitis diagnosis by getting your medical history and performing a physical examination. During the physical exam, your physical therapist will determine the level of stiffness in the hip and will detect any present limp. You may undergo additional physical tests to determine other possible causes of your pain. Your physical therapist will also ask when your pain began and what motions cause pain in the hip.

In some cases, patients are referred to a doctor for additional diagnosis. After you’ve completed your diagnostic examination, you will work with the team at Hicksville Physical Therapy to explore treatment options that can increase recovery speed, allowing you to return to your daily activities.

Related Document: Osteoarthritis of the Hip

Our Treatment

Non-surgical Rehabilitation

The team at Hicksville Physical Therapy treats cases of trochanteric bursitis starting with simple measures to reduce inflammation, often including the application of ice or heat. Our physical therapists use hands-on treatment and basic stretches to help you regain your entire range of motion in the hip. As you gain coordination and strength in the buttock and hip muscles, your femur will be able to move smoothly in the socket, reducing friction on the bursa. While recovery time varies from patient to patient, it is typical to spend four to six weeks attending physical therapy sessions before you regain your full function and motion.

Younger patients with trochanteric bursitis caused by overuse can typically treat their condition by reducing or changing their daily activities. A decrease in activity, in combination with our exercise physical therapy program, and sometimes a short course of anti-inflammatory medicine, will normally solve the issue. Patients may also choose to speak with their doctor or pharmacist about using pain relief or anti-inflammatory medicine.

The vast majority of trochanteric bursitis patients we treat never require surgery. However, if you do, the team at Hicksville Physical Therapy will provide you with a customized physical therapy program to decrease your recovery time and allow you to quickly return to your normal activities.

Post-surgical Rehabilitation

If you undergo surgery, your hip will be covered and protected with a dressing and padding. The amount of physical therapy needed will vary by patient, but typically, patients at Hicksville Physical Therapy could attend sessions for up to two months following surgery.

In the first several treatment sessions, you will focus on controlling the swelling and pain that can result after surgery. Then, you will begin exercises to strengthen and stretch the muscles surrounding the hip joint. Your physical therapist will work with you to retrain these muscles and keep the femur’s ball moving smoothly. You will also be given tips to perform your daily activities without adding strain to the hip joint.

The team at Hicksville Physical Therapy has one goal: to help quicken your recovery so that you can easily return to your daily routine. When you’ve been in recovery for quite some time, you will stop visiting our office regularly. We will still be a resource for you, but you will become responsible for continuing your exercises as part of a lasting home program.

Physician Review

Your physician may order X-rays to ensure that your hip contains no other abnormalities. Although X-rays normally do not show trochanteric bursitis, they can help eliminate the possibility of other issues that may cause hip pain. Sometimes, it can be hard to distinguish whether your hip pain is resulting from trochanteric bursitis or from underlying arthritis of the hip joint. An X-ray can provide additional information about the condition of the hip joint.

Your doctor may also inject a local anesthetic into the bursa to diagnose trochanteric bursitis. If your pain immediately stops after the injection, then a trochanteric bursitis diagnosis is likely. In many cases, physicians will add a small amount of cortisone medication to the novocaine, helping to treat the condition simultaneously. Cortisone is a strong anti-inflammatory medication that, when injected into the bursa, can reduce pain and swelling. While the injection will likely not cure the condition, it can help to control symptoms for months.

Surgery

Most cases of trochanteric bursitis do not require surgery. However, your doctor might recommend surgery if your pain is debilitating and if non-surgical treatment methods have failed. There are several types of surgery that may treat trochanteric bursitis.

The main goal of any trochanteric bursitis surgery is to remove the thickened bursa and any bone spurs that may be present on the greater trochanter, as well as to relax the large tendon of the gluteus maximus. Some surgeons choose to lengthen the tendon, while others will remove a small section of the tendon that is rubbing right on the greater trochanter. Either procedure has shown positive results.

Related Document: A Guide to Trochanteric Bursitis Surgery

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