Trochanteric bursitis


Trochanteric bursitis is characterized by painful inflammation of the bursa located just superficial to the greater trochanter of the femur

Causes

Acute trauma (eg, from a fall or tackle) that causes the patient to land on the lateral hip region can result in trochanteric bursitis. More commonly, repetitive (cumulative) trauma is involved. Such trauma is caused by the repetitive contracture of the gluteus medius, the ITB, or both during running or walking.

Conditions that predispose patients to trochanteric bursitis include underlying lower leg gait and back or sacroiliac disturbances. Osteoarthritis of the hip may also be responsible, though this diagnosis generally manifests as groin or knee pain rather than lateral hip pain. At times, the bursitis develops spontaneously without apparent precipitating factors.

Trochanteric bursitis is relatively common among physically active and sedentary patients. The prevalence of unilateral bursitisis 15.0% in women and 8.5% in men, and that of bilateral bursitis is 6.6% in women and 1.9% in men. In a study by Lievense et al, the annual incidence of trochanteric pain in primary care was reported as being 1.8 per 1000 patients.

Trochanteric bursitis can occur in adults of any age. Lievense et al found that trochanteric bursitis appeared to be much more common in females (80%) than in males.

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Location of pain with trochanteric bursitis

Management

The line of management of trochanteric bursitis varies. It often starts with input from physiotherapist to stretch the iliotibial band and use of heat, ultrasound and acupuncture.

Most patients with trochanteric bursitis respond very well to a combination of corticosteroid injection, physical therapy, and activity restriction. Some patients may require repetition of the corticosteroid injection.

A randomized, controlled clinical trial found corticosteroid and lidocaine injection for trochanteric bursitis to be an effective therapy that provided a prolonged benefit.  Lievense et al found improvement rates of 60-66% at follow-up visits 1 year years

In a multicenter, open-label, randomized clinical trial from the Netherlands that evaluated the corticosteroid injections found a clinically relevant effect at 3 months for pain at rest and with activity. However, at 12 months, the differences in outcome were no longer present was no longer evident in the group with or without  steroid injection

Studies by Furia et al and Vannet et al demonstrated that low-energy extracorporeal shock wave therapy (ESWT) is an effective treatment for GTPS, especially for those who have high signals on MRI.

A study by Rompe et al showed that ESWT yielded significantly better results than home exercises or corticosteroid injections.

A retrospective study of 164 patients who presented with trochanteric pain found that at least 36% were still symptomatic after 1 year and 29% were still symptomatic after 5 years; thus, many patients developed chronic pain at this site. Patients with osteoarthritis (OA) in the lower limbs had a 4.8-fold greater risk of persistent symptoms after 1 year than patients without OA. Patients treated with corticosteroid injection were 2.7 times less likely to have chronic pain at this site at 5 years than patients who were not treated in this manner.