Category Archives: trochanteric bursitis

What the heck is “pseudosciatica”?

Sciatica is a condition where nerve roots in the lower portion of the lumbar spine become irritated as a result of disc bulge, disc herniation, or osteoarthritis.

There is also a condition called “pseudosciatica” which mimics sciatica.  It can pose a real diagnostic challenge.  Conditions that cause pseudosciatica include

1. trochanteric bursitis: a form of bursitis that causes pain in the lateral hip.  The pain is aggravated by climbing stairs and by lying on the affected side.

2. pyriformis syndrome: a problem that occurs when a swollen pyriformis muscle places pressure on the sciatic nerve.  This occurs after over exertion or after a fall on the buttock.

3.iliotibial band syndrome. A problem that occurs in runners with pain in the lateral hip radiating down the side of the leg.sciatica2

The examining doctor needs to be aware of these “foolers” and perform a careful history and physical examination.

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Why is PRP being used by athletes?

The use of regenerative treatments such as PRP and autologous stem cells have revolutionized our approach to athletic injuries and also to tendinopathies involving Boomer athletes.

PRP is an ultraconcentrate of blood that contains a large number of platelets, prpcells packed with growth and healing factors.

PRP ideally is administered using an ultrasound guided needle tenotomy injectingprptoankle-mmiller-13technique.  What this entails is using a small gauge needle to “pepper” the area of tendon damage to induce an acute inflammatory response.  Inflammation is the first step in healing. Inflammation causes the platelets to release their growth factors and initiate the healing of the damaged tendon.  The inflammatory phase lasts roughly about a week.  The healing phase lasts about 3-04 weeks.  The final stage is the reorganization phase where the tendon fibers are organized into a normal fiber pattern.  This can take up to a year.

Nonetheless, the ability to heal tendon damage withour having to resort to surgery is exciting.  In those patients who don’t respond to two PRP treatments, autologous stem cells are indicated.

 

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What can be done about trochanteric bursitis

Bursae are small sacs that contain minute amounts of fluid. They are located around most joints and are responsible for cushioning. When they become inflamed, the condition is referred to as “bursitis.”

One of the most common causes of hip pain is trochanteric bursitis. It is an affliction of middle-aged to elderly people and tends to affect women more often than men. Patients are often overweight.

hip-painThe primary symptom is aching pain located on the side of the hip at an area called the “greater trochanter”. The pain sometimes radiates down the side of the thigh.

The pain is aggravated by walking, climbing stairs, and lying on the affected side. The pain tends to come on gradually and can become so severe the patient has difficulty walking. In some cases, trauma plays a role and can cause a more acute onset of pain.

On examination, there is tenderness located over the lateral hip. The pain elicited by examination can be excruciating. Having the patient lift their leg laterally (to the side) can also bring out the pain. There may be a noticeable limp.

The condition is almost always accompanied by tendinopathy, meaning the tendons overlying the bursa are diseased or damaged. The two tendons that are most often affected are the gluteus minimus and gluteus medius.

Some conditions can predispose to trochanteric bursitis. These include scoliosis as well as leg length differences.

The diagnosis is suspected clinically and can be confirmed by magnetic resonance imaging (MRI). Another condition that can mimic this problem is sciatica.

The treatment initially can be conservative with stretching of the gluteus medius and gluteus minimus tendons as well as the iliotibial band, a long ligament that stretches from the greater trochanter of the hip down to the knee. Non-steroidal-anti-inflammatory drugs (NSAIDS) can provide symptomatic relief as can ice packs or moist heat.

Patients who are overweight should be counseled regarding weight loss.

In stubborn cases, ultrasound guided injections of glucocorticoid (“cortisone”) may be useful. These injections should be used sparingly because they may cause more tendon degeneration.

Patients who continue to have symptoms will require a procedure called ultrasound-guided percutaneous needle tenotomy accompanied by platelet-rich plasma (PRP).

The theory here is that using a small gauge needle to poke holes in the area of degeneration will induce an acute inflammatory response. This causes the release of active growth and healing factors from the platelets in the platelet-rich plasma. This procedure will lead to healing of the diseased bursa and adjacent tendons.

For more information on trochanteric bursitis treatments and other arthritis problems go to:

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