What is Trochanteric bursitis?
A bursa is a thin-walled sac filled with a very small amount of fluid that is usually found over bony prominences and functions to help soft tissues to glide over these prominences.
The trochanteric bursa lies over the bony greater trochanter in the upper outer thigh. Trochanteric bursitis, sometimes called Greater trochanteric pain syndrome, causes pain in this region that can vary from mild pain to disabling pain that requires the use of crutches to walk.
It can be caused by a number of things. Anything that causes an alteration in the way that a person walks can cause the condition. This includes anything that causes a limp, such as a foot injury, foot surgery, knee problems etc. It can also be caused by a fall directly onto the greater trochanter. As an overuse injury it can also occur in runners and other sports-active people. It can also occur in people who have had hip surgery, for example a hip replacement.
The condition can occur in association with iliotibial band (ITB) syndrome, where pain is felt along the outer thigh especially at the outer aspect of the knee. The pain occurs along the path of the fibrous iliotibial band which is a structure that is important in knee movements.
How is it diagnosed?
Symptoms are often confused with those of hip arthritis, but diagnosis by a specialist is usually straightforward. X-rays are usually performed to exclude other possible hip problems.
How is Trochanteric bursitis treated?
Treatment starts with simple measures, and these are often effective. Rest, icing, anti-inflammatory tablets and painkillers can help symptoms.
Physiotherapy exercises stretches can also help. In cases that follow total hip replacement surgery, however, such exercises cannot be safely performed.
Sometimes the condition does not respond to these simple measures. In these cases other treatments are considered. A steroid injection can be performed and often helps the pain, but not in every case. When the injection does help, the effect often wears off after 3-6 weeks and the pain returns.
Again, patients who have had a total hip replacement may not be considered for a steroid injection due to the small risk of infection in the soft tissues and therefore of the replacement itself.
What is the role of Shock wave Therapy?
Shock wave therapy is considered in cases that haven’t responded to the previously discussed measures and as a first line treatment for Trochanteric bursitis in those who develop this condition after total hip replacement surgery. It results in a healing response that can cure the condition. It involves no needles, no anaesthetic and is performed in the out-patient clinic. It is also very safe in all cases. In trochanteric bursitis cases our results show that 70-80% of people have been successfully treated.
In the very few cases that do not respond to all these measures surgery may be required. This is commonly performed through key-hole surgery.
We have found shock wave therapy to be 70-80% successful for trochanteric bursitis treatment in a wide range of patients; some of whom have had the condition for a number of years