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.
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.
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