TROCHANTERIC BURSITIS

Trochanteric bursitis (gluteal tendinopathy) is a type of ‘tendon disorder’ in your hips and buttocks area (gluteal region). These include the gluteus maximus, medius and minimus. As your tendons are strong, flexible tissues that connect your muscles to your bones, they work together to help you move, run, walk, sit, and stand and when something irritates, inflames, or injures your tendons, you experience pain.

The bony prominence located on the outer side of your hip, where a pants pocket would be, is called the greater trochanter. It is a part of the femur (thigh bone) that can be felt and moved during hip motion. The greater trochanter slides past the iliotibial (IT) band smoothly without friction, aided by the trochanteric bursa – thin, fluid-filled sacs of tissue that lubricate the hip area. This lubrication facilitates painless movement of the joint.

If the trochanteric bursa becomes inflamed however, it can result in pain during hip motion, a condition called trochanteric bursitis, also known as hip bursitis. This condition is common among older individuals and younger athletes who engage in activities such as running.

Causes of trochanteric bursitis 

There are around 160 bursae throughout your body. Their purpose is to act as a cushion between your bones and soft tissue and to prevent your bones from rubbing against your tendons and muscles. Unfortunately, when one or more bursae becomes inflamed, the unpleasant side effect is pain. Falling onto your hip, bumping your hip into an object, or lying on one side of your body for an extended period can make you more susceptible to bursa inflammation causing pain. Play or work activities that cause overuse or cause injury to the hip joint, incorrect posture, stress on the soft tissues or other diseases or conditions may also be contributing factors to trochanteric bursitis.

Trochanteric bursitis is more common in women and in middle-aged or elderly people with potential causes of tendon injury including:

• Overuse, e.g., from putting too much force on your tendons during physical activities 
• Tendon compression due to a fall or another type of accident
• Excess pressure on the tendons from weight gain or obesity.
• From an inactive or a sedentary lifestyle (underuse).
• From having a wide pelvis or hip instability.

Symptoms of trochanteric bursitis

The most notable sign of trochanteric bursitis is moderate to severe hip pain. This pain extends down the outside of your leg to your knee or lower leg. You may also experience lower back pain, groin pain or gluteal pain. The pain often starts at the greater trochanter, at the top of your thighbone and the area will often feel tender to touch.

Diagnosing trochanteric bursitis

To diagnose trochanteric bursitis, Dr Singh will go through all your medical history, followed by a physical examination. Your medical history is compiled by asking you questions about your hip pain, any medications you may be taking, and prior injury and other bone and joint problems you may have. The physical examination will evaluate your range of motion and Dr Singh will observe how you walk, sit, bend, and move which all assist with your assessment and diagnosis.

Further testing is sometimes required including x-ray’s, blood tests, or an MRI however, tenderness and swelling around your pain and over the bursa, during the physical examination of the hip usually confirms a diagnosis of trochanteric bursitis.

Treating trochanteric bursitis

Treatment goals include reducing pain and inflammation (swelling), preserving mobility, and preventing disability and recurrence.

To lower your risk of developing trochanteric bursitis it would be beneficial to:

• Stay physically active
• Modify or take a break from activities that irritate your hips (like running)
• Avoid repetitive activities that put a lot of pressure on your hips (like squats)
• Lift weights to strengthen your gluteal muscles 
• Practice yoga or stretching exercises to keep your hip muscles flexible
• Practice good posture
• Maintain a healthy weight

Physiotherapy can also help to alleviate symptoms along with pain medications.

The treatment of hip bursitis can vary, depending on your diagnosis and pathology present. Initially, it may seem obvious, but avoiding situations that cause pain in the area is essential. This usually means adopting a comfortable sleeping position at night, avoiding lying on the sore side, putting a pillow between your legs if lying on the opposite side, or lying on your back to avoid direct pressure to the painful area.

If conservative treatment measures fail to alleviate pain, or when there is tearing and degeneration of the gluteal muscle tendons that attach to the greater trochanter surgery may be required. Surgery for gluteal tendinopathy can include a gluteal tendon repair, removal of the bursa, and removal of the bone underlying the tendon. This surgery aims to stimulate the tendon environment by improving blood flow and promote healing in the tendon cells.

A crucial aspect in determining the most appropriate treatment for hip pain is obtaining an accurate diagnosis, as several medical conditions can contribute to this discomfort. Consulting with Dr. Singh can aid in achieving a correct diagnosis and help you identify the optimal treatment plan for your specific injury.