Trochanteric bursitis is a condition involving pain at the side of the hip, primarily caused by a tendinopathy of the gluteus medius or gluteus minimus. The condition may or may not leave the hip bursae unaffected.
Trochanteric bursitis causes rather typical symptoms. The main symptom is pain, that is profoundly felt at the hip joint and spreads to the lateral side of the hip, although it does not affect the whole length of the leg. The pain worsens when one engages in physical activity of any type, including walking, running etc., or when one simply lies down on that side while sleeping.
Other typical findings include a considerable point tenderness at sites proximal to the trochanteric region . Edema of the bursal region may also be present, but it is usually difficult to palpate. Movements carried out by the physician, such as an external hip rotation or flexion, induce further pain in patients suffering from trochanteric bursitis . The types of movements that cause pain can be used diagnostically to differentiate between trochanteric bursitis and other pathologies leading to a similar clinical picture .
Trochanteric bursitis is diagnosed clinically and following the exclusion of other conditions that lead to a similar set of symptoms. The patient is expected to report symptoms such as pain radiating laterally down to the thigh, which worsens with physical strain. Laboratory testing serves as a method to exclude other potential pathologies, such as infection or autoimmune diseases, and imaging modalities, such as magnetic resonance imaging and computerized tomography scans, radiographs and ultrasonographic scans also serve as ways to exclude other conditions. A neurological assessment of the region is mandatory when the patient presents with such symptomatology and, should traumatization precede the onset of symptoms, the patient needs to be thoroughly evaluated for fractures before the diagnosis of trochanteric bursitis can be decided .
Greater trochanteric pain syndrome is mainly treated symptomatically. The application of cold compresses on the hip joint, avoiding physical exercise or excessive mobility, injected corticosteroids and the administration of painkillers, such as NSAIDs (non-steroidal anti-inflammatory drugs) are the most popular treatment options  . Patients whose condition fails to ameliorate, despite appropriate therapeutic measures, may need to consult an orthopedic surgeon . Special consideration should be taken with reference to age groups that may have some limitation regarding drug ingestion: the use of NSAIDs should not be liberal by the senior population and women who are expecting should avoid corticosteroid injections as the pregnancy progresses.
Posture and gait defects should also be addressed, as they contribute to the pathogenesis of greater trochanteric pain syndrome. Orthotics, braces, canes and various other devices can be prescribed, in order to correct the way a patient walks. In case the aforementioned measures do not achieve a satisfactory degree of improvement, other options, including transcutaneous electrical nerve stimulation or extracorporeal shock wave therapy, can be chosen.
Corticosteroid injections are also widely prescribed for the treatment of trochanteric bursitis. It has been observed that they exhibit considerable success in terms of pain management and in the duration of the results. The only contraindication for injected corticosteroids is advanced pregnancy and a hip that seems infected. Physical therapy, on the other hand, is an option to rehabilitate such patients: targeted exercises may help some patients recover faster. At the same time, maintaining low levels of strenuous activity is vital to avoid excessive pressure to the joint. As a last resort, surgery can correct the syndrome if conservative symptomatic treatment fails to do so .
The condition does not lead to death, but may cause considerable morbidity to affected individuals. Painful symptoms are usually experienced periodically and a certain degree of limping may be anticipated in some cases as well . Treatment options, such as corticosteroid injections and physical therapy usually suffice to treat the symptoms.
There are many factors that contribute to the onset of trochanteric bursitis. An individual that has sustained trauma to the hip joint and particularly those whose daily physical activity leads to multiple falls (eg. athletes) or other types of trauma to this region, are susceptible to developing bursitis. Underlying conditions that affect the skeletal system, such as spinal deformities, or other conditions leading to an abnormally balanced gait can also contribute to the pathogenesis of the disease. Lastly, trochanteric bursitis can arise as a result of the piriformis syndrome, characterized by the insertion of the piriformis muscle into the trochanteric bursa or following arthroscopic surgery, although the latter occurs rarely   . Some patients may experience symptoms related to trochanteric bursitis without any of the aforementioned factors.
Trochanteric bursitis usually affects individuals older than 50 years old and exhibits a predilection for female patients. The discrepancy between women and men is greater when the bursitis affects both hips , and, in general, it has been estimated that women are affected by the condition as much as 4 times more frequently than men.
The basic pathophysiological alteration featured in cases of trochanteric bursitis include inflamed bursae. This inflammatory process is mostly induced by excessive physical exercise that leads to repeated falls with the side of the hip; other causes include a difference in the length of the patient's legs and surgical procedures performed on the hip . During the past years, given the fact that other regional structures such as tendons or muscles are affected in cases of trochanteric bursitis, the condition is widely referred to as greater trochanteric pain syndrome   . Another reason for this classification change is that, apart from trochanteric bursae, there is a plethora of other regional bursae that may undergo an inflammatory process as well.
The key to preventing the occurrence of greater trochanteric pain syndrome is maintaining a healthy lifestyle, protecting oneself from repeated falls that damage the hip and engaging in physical exercise in such a way, so as to minimize damage dealt to the joint. Proper shoes that do not exert abnormal pressure to the legs are of paramount importance, as are special shoes designed for flat feet.
Trochanteric bursitis is otherwise known as greater trochanteric pain syndrome. It is a condition causing inflammation of the bursae which are adjacent to the greater femoral trochanter   . Pain at the hip joint that extends to the sides of the thigh is the predominant symptom .
Trochanteric bursitis is diagnosed clinically and with the aid of imaging modalities capable of evaluating the condition of the bursae, such as an ultrasonographic scan or a magnetic resonance imaging scan (MRI). Laboratory testing, X-ray scans and computerized tomography scans are mainly carried out in order to eliminate the possibility of other diseases, which can lead to similar symptomatology. The condition is treated symptomatically, with the administration of painkillers, physical therapy, corticosteroids and local anesthetics. Patients are advised to engage in physical exercise that does not burden the hip in an excessive manner, and a plethora of therapeutic options are available for those who do not respond to conservative treatment.
The hip joint is protected by the bursa, a sac filled with fluid that serves the purpose of a "shock-absorber", in order to minimize damage and friction between structures like the muscle, bone or tendon. The hip joint is one of the biggest joints of the body and withstands a great deal of pressure and weight on a daily basis. Under various circumstances, the protective bursa is damaged, becomes swollen or infected and leads to a condition referred to as the greater trochanteric pain syndrome, or trochanteric bursitis.
There are various causes that can lead to this condition. Amongst the popular ones are: repeated trauma to the hip due to a fall or blow to the area, excessive physical exercise that damages the hip, a difference in the length of one's legs and spinal deformities (eg. scoliosis). An infection can also cause this condition, as can many other systematic diseases, such as diabetes, gout or thyroid conditions. Trochanteric bursitis typically causes pain on one or both hips that reaches all the way down to the knee, while usually sparing the foot, swelling and a tingling sensation when one moves. Patients face a great deal of difficulty when walking or resuming motion after having remained in a sitting or lying position for a long time.
The condition is diagnosed with the aid of the medical history and symptoms, physical examination and tests that are mainly performed to rule out other causes, rather than to confirm trochanteric bursitis.
The first steps towards the reduction of pain and related symptomatology is applying some basic personal measures. Patients are advised to sleep with their weight on the hip that is unaffected, rest a lot and avoid intense physical activity that involves the legs and can burden the hip. Applying ice on the hip can help to reduce the swelling, and painkillers should also be encouraged if the pain is intolerable. Remaining in a standing or sitting position for a long time can adversely affect the hip joint; it should therefore be avoided. Footwear should be appropriate for the type of exercise undertaken, comfortable and orthotics should be prescribed for people with feet problems, since the feet influence the posture as well.
As far as further medications are concerned, corticosteroid injections have been proven efficient in reducing symptoms and achieving long-term results. There are other therapy options available for cases that do not respond to the types of treatment mentioned above, and surgery is chosen as the last option if nothing else proves beneficial.