MRI is the investigation of choice as it can show all forms of pathology in both the soft and bony tissues of the trochanteric region as well as the hip joint itself. Figure 4. MRI scan indicating fluid in an inflamed trochanteric bursa left and no fluid right. The natural history of TPS, even if untreated, is usually one of slow resolution over a period of months to years.
In almost every case, conservative or non-operative treatment is the appropriate first line management. It may seem obvious, but avoidance of situations that cause pain is essential — continuing with painful activity will never allow this condition to settle.
This usually means adopting a comfortable sleeping position at night — avoiding lying on the affected side, putting a pillow between the legs if lying on the opposite side or lying on the back to avoid direct pressure on the painful area.
Instruction from a therapist regarding the use of a foam roller or similar device over the trochanter and fascia can complement an exercise program. Figure 5. Analgesic medication and local heat can reduce the pain of TPS. Sometimes multiple cortisone injections are required, spread out over a period of time.
Figure 6. Ultrasound guided injection of local anaesthetic and steroid into the trochanteric bursa. Surgical treatment of TPS is rarely required or indicated. Surgery unfortunately is not always successful and it is impossible to predict the outcome pre-operatively. Despite undertaking all the correct steps, a proportion of individuals with TPS undergoing surgery will still continue to have pain and functional limitation.
If surgery is to be undertaken, identification of all the pathologies involved and addressing each of these with the operative procedure is important. Surgery clearly carries some risk — infection, deep vein thrombosis, nerve or vessel damage and anaesthetic complications are possible — and is always absolutely a last resort attempt at symptom improvement in most cases of TPS.
When they work normally, bursae help the tendons, ligaments, and muscles glide smoothly over bone. But when the bursae are swollen, the area around them becomes very tender and painful. Trochanteric bursitis is swelling affecting the bursae of the hip. Bursitis does not only happen in the hip. It can also occur in the shoulder, knee and elbow joints. Bursitis may be acute short-lived or chronic long-lasting. Symptoms include joint pain and tenderness. You may also see swelling and feel warmth around the affected area.
The pain is often sharp in the first few days. It may be dull and achy later. You may notice it more when getting out of a chair or bed. You may also notice it when sitting for a long time and when sleeping on the affected side. Acute bursitis usually flares over hours or days. Chronic bursitis can last from a few days to several weeks. Chronic bursitis can go away and come back again. Acute bursitis can become chronic if it comes back or if a hip injury occurs.
Over time, the bursa may become thick, which can make swelling worse. This can lead to limited movement and weakened muscles called atrophy in the area. Your doctor will examine you and ask about your symptoms. Sometimes certain tests may be needed to rule out other conditions that can cause similar symptoms.
These tests may include X-rays and magnetic resonance imaging MRI. You can avoid getting bursitis by not putting too much strain on your hips.
Avoid activities that are especially difficult or painful. And take breaks to rest your hips. When you exercise, remember to warm up your muscles and then stretch to prevent injury.
Building strength in your hips with an approved workout routine can greatly reduce your chances of getting bursitis. Ask your doctor what types of exercise are best for you. Treatment for bursitis usually involves doing strengthening exercises and stretching. This helps prevent muscle atrophy. You should avoid activities that cause pain. The purpose of a healthy bursa is to reduce friction between bone and surrounding soft tissue, such as skin, muscles, ligaments and tendons.
There are more than bursae in the body, 1 several of which are found near the hip joint. The greater trochanter is the bony knob near the top of the thighbone femur , where the upper thigh curves outward. The trochanteric bursa is located over this bony knob. When the trochanteric bursa becomes inflamed, it is called trochanteric bursitis, or hip bursitis. The trochanteric bursa typically becomes inflamed because of:. In addition to the trochanteric bursa, there are other bursa located near the hip joint.
One of them, called the iliopsoas bursa, is located near the groin, under the iliopsoas muscle. If this bursa becomes irritated, the condition is called iliopsoas bursitis or iliopectineal bursitis. This condition is also generally referred to as hip bursitis. Diagnosis and treatment for the two types of bursitis are similar. This article focuses mainly on trochanteric bursitis, which is more common. See why the complex hip joint structure is susceptible to arthritic conditions.
Read more about Hip Anatomy.
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