A bursa is a thin sac of fluid that creates a gliding surface for skin or tendons as they glide over or under bony prominences in the body. There are several bursas around the hip, but the largest is the trochanteric bursa, which overlies the bony prominence on the outside of the hip. This bursa can become inflamed, causing hip pain with simple movements.
Trochanteric bursitis, or inflammation of the bursa over the greater trochanter, may be caused by a forceful impact to the side of the hip or from altered hip mechanis. There are several great treatment options available that can help alleviate the inflammation in the bursa and restore function. This condition usually resolves with formal physical therapy aimed at strengthening core and hip muscles, as well as anti-inflammatory pain medication. Occasionally, steroid injections into the bursa are used when patients fail to respond to more conservative treatments.
- Deep ache over the lateral hip that is worse with activity or pressure on the side of the hip
- Persistent hip pain when raising the leg out to the side or across the body
- Limited range of motion due to pain
- Strength is preserved
- Physical Therapy - A formal course of physical therapy (PT) is the first line of treatment. PT can help patients regain their strength and range of motion as well as restore the mechanics to the affected joint.
- Injections - Injection of a steroid into the subacromial bursa is a very effective way to reduce the inflammation and pain. It can provide results within one day. It is not recommended to have more than a couple of injections into the bursa because repeat steroid injections around the tendons in the hip can weaken the tendon and potentially lead to tears.
- Anti-inflammatories - Nonsteroidal anti-inflammatory medications such as Ibuprofen or Aleve can help decrease inflammation and pain in the subacromial bursa. This can be beneficial in addition to physical therapy, so patients can have less pain while regaining their motion and strength. Prescription-strength anti-inflammatory medications are occasionally prescribed if over-the-counter medications are not working.
- Surgery - This is rarely needed for cases of trochanteric bursitis. It is important to evaluate for primary causes of this condition when patients fail to respond to more conservative treatments.
Trochanteric bursitis can be diagnosed clinically with a detailed history and a thorough physical exam. If patients demonstrate weakness, an MRI will be ordered to ensure no other soft tissue structures have been injured. An MRI evaluates soft tissue structures such as the abductor tendons and can show fluid in the trochanteric bursa.
Typically, trochanteric bursitis is managed conservatively. Most patients improve without needing surgery. If patients continue to have pain and limitations despite physical therapy, steroid injection, and anti-inflammatories, surgery to remove the inflamed bursa can be considered.
The most common risks are stiffness, persistent pain, and weakness. Patients with trochanteric bursitis commonly use their painful leg less, which can lead to weakness in the hip as well as increased tension in the muscles around the hip.