The trochanteric bursa is a small fluid filled sac which lies on the outer aspect of the hips. The bursa lies directly over a bony protuberance named the greater trochanter. A strong band of soft tissue (the iliotibial tract) and the tendons of the gluteal muscles lie over the bursa. The area of the greater trochanter is the one which we can feel directly at the top and outside of the thigh.
Trochanteric bursitis is a term which is used to describe inflammation and pain to this fluid filled sac. In recent years it has been found that alongside trochanteric bursitis there may be tears and inflammation to the gluteal tendons as well. For this reason, some healthcare professionals now use the term greater trochanteric pain syndrome.
Symptoms of trochanteric bursitis is mainly pain directly over the greater trochanteric region. In some cases this pain radiates down the thigh to the outer aspect of the knee. In severe cases there may be a clunking when the hip is moved as the iliotibial tract rubs over the bony trochanter.
Once inflamed, pain from trochanteric bursitis may be felt during a number of static postures or activities for a number of reasons. The most common complaint is pain when lying directly on the painful side. However, many sufferers also feel pain when lying with their painful side uppermost. This is due to the iliotibial tract being under tension and compressing the inflamed bursa. Sitting for sustained periods is another common complaint for the same reason. Sitting cross legged immediately places the iliotibial tract under considerable tension and often significantly aggravates the pain.
Activities which aggravate trochanteric bursa symptoms may include climbing stairs or walking for unaccustomed periods of time. The repetitive forward motion of the hip and knee may cause repetitive friction of the iliotibial tract over the bursa.
It is important to note that although the above factors may aggravate symptoms once the bursa or tendons are inflamed, the underlying cause for trochanteric bursitis often lies in abnormal biomechanics and requires expertise in physical examination and sometimes specialist diagnostics.
Circle Health offer immediate appointments with orthopaedic hip specialists who are able to carefully diagnose trochanteric bursitis and it’s underlying causes. Factors will be explored such as time spent sitting and the ergonomics of this posture, possible unaccustomed training load if exercising. A physical examination will analyse the rom of motion of the hip joints and flexibility of the muscle groups around the hips including the iliotibial tract. Particular patterns of stiffness as well as possible structural problems such as leg length discrepancy or wide pelvic positions (often in women) can all cause trochanteric bursitis.
Once a provisional diagnosis is made, a Circle Health orthopaedic hip specialist is able to request diagnostics as required. Normally in the case of suspected trochanteric bursitis an ultrasound scan may be performed which is able to detect inflammation to the bursa and any possible gluteal tendon changes. In some cases an x-ray may help to exclude hip osteoarthritis as an underlying cause.
The majority of cases of trochanteric bursitis resolve without the need for any invasive intervention. However, when treating this condition with activity modification and physiotherapy exercises significant patience may be needed.
Activity modifications to reduce pain may include:
- Reducing the time spent walking
- Modifying technique for walking upstairs (in severe cases)
- Stopping sleeping on the painful side and placing a pillow between the knees if sleeping on the non painful side
- Stopping sitting in a crossed legged position and raising the seat
Physiotherapy exercises to treat trochanteric bursitis are mainly aimed at strengthening the gluteal muscles. This has two effects. The first is that placing load through these muscles also loads the the gluteal tendons. In the event that there is inflammation of the tendons contributing to the pain, this loading stimulates them to heal. The second benefit is that strengthening the gluteal muscles helps to prevent excessive rotation of the hips and knees which can predispose to developing trochanteric bursitis.
Some cases of trochanteric bursitis may not settle entirely even with appropriate physiotherapy management. As such, ultrasound guided corticosteroid injections may be advised in specific circumstances by an orthopaedic consultant.
In very rare circumstances when physiotherapy and corticosteroid injections have failed, an orthopaedic hip consultant may be able to offer an operation to remove the trochanteric bursa to relieve pain. In these circumstances there may be associated tears seen to the gluteal tendons on diagnostic imaging which may be repaired during the same procedure.
Whether an initial consultation or follow up appointment is made with an orthopaedic hip consultant at Circle Health, they will be able to guide your management for trochanteric bursitis in the most appropriate direction according to your individual circumstances.