Definition

Trochanteric bursitis is the inflammation of the bursa, a fluid filled sack that is located on the great trochanter of the femur, beneath the tendons and muscles of the buttocks.

Pathology

Trochanteric bursitis is a disease mostly caused by the friction to the bursa that is located between the great trochanter (the side tip of the femur) and the iliotibial band (tendon) that runs along the external thigh. Numerous gluteal muscles insert at the great trochanter. They are used for activities such as walking, running, climbing and jumping. In particular the contraction of the gluteus maximus, which is attached to the iliotibial band, exerts a significant pressure to the bursa as it forces the sliding of the band around the great trochanter. Weakness of the gluteus medius may also lead to the irritation of the bursa.

This pathology is frequent in older individuals and athletes due to muscles weakness and repetitive activities that pose a strong pressure on the bursa. In elderly individuals the iliotibial band can become tight causing pressure on the bursa, thus triggering its inflammation and swelling. A trauma to the hip side may also provoke bleeding and formation of a haematoma within the bursa, leading to inflammation, thickening of the bursal capsule and trochanteric bursitis.

Causes

There is a number of causes leading to trochanteric bursitis but in some cases the origin of the disease is unknown. These are:

Trauma

Fall

Lack of training, muscle weakness

Excessive training

Leg length discrepancy

Joint stiffness

Muscle tightness

Risk factors

Leading risk factors for a trochanteric bursitis include:

Excessive or inadequate training

Elderly age predisposing to falls

Runners (especially on hard surface)

Female gender

Previous hip replacement or other hip surgeries

Symptoms

The most frequent symptoms of trochanteric bursitis are:

Pain to the lateral hip side (initially)

Pain radiating along the outer thigh up to the knee (when chronic)

Pain when touching the bursa

Pain when sleeping on the side

Stiffness of the hip joint

Difficulty in walking, limp

Weakness of the lower limbs

Treatment

Nonoperative treatment

Management of trochanteric bursitis begins with conservative treatment, which is mostly successful although with a lengthy prognosis. This approach involves:

Anti-inflammatory therapy with NSADs

Local injection of steroids

Local injection of platelet-rich plasma (PRP)

Reduction of physical activity and extreme sport

Physiotherapy

Surgical treatment

Surgery is recommended only rarely when a chronic bursitis fails to resolve with conservative treatment. Different methods are available that vary between open surgery and less invasive arthroscopic surgery. The ultimate goal is the removal of the inflamed, sclerotic bursa and excise any bone spurs that may have formed. The surgeon may choose to lengthen the tendon of the gluteus maximus that has caused the pathology or remove part of the tendon covering the bursa to prevent local frictions and recidivism of the pathology.