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Trochanteric  Bursitis
 

Trochanteric Bursitis

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  • Calsifications around the GT may be evident in 40%

Trochanteric  Bursitis Trochanteric Bursitis Presentation Transcript

  • Trochanteric Bursitis
  • The four trochanteric busra are situated deep to the soft tissues at the lateral hip, protecting them from the bony surface of the greater trochanter (GT)
        • The subgluteus maximus is the largest
          • measuring 2-4 cm width and 4-6cm length and serves as a sliding mechanism to the tendon of the gluteus maximus passing over the GT to insert in the iliotibial band
  • History
      • Deep aching pain sometimes associated with burning sensation on the lateral aspect of the hip and thigh
      • Pain increases with activity
      • Worse at night when lying on the affected side
      • Associated with a limp in 15% of cases
  • Clinical features
    • Tenderness on palpation of the area around the greater trochanter – may feel boggy in thin patients
    • Resisted abduction of the hip when the patient is lying on the opposite side may accentuate the pain
    • Movements of the hip usually normal
  • Differential diagnosis
    • Hip disease
    • Referred lower back pain
    • Stress fracture
    • Local infection
    • Tumour/metastatic disease
  • Clinical criteria for the diagnosis of trochanteric bursitis 1985 Ege Rasmussen and Fano
    • Aching pain in the lateral aspect of the hip
    • Distinct tenderness around the greater trochanter
    • Pain at the extreme of rotation, adb/adduction
    • Pain on forced hip abduction
    • Pseudoradiculopathy
      • Diagnosis requires presence of the first two and one of the other three
      • Not been validated
  • Clinical features
    • More common in women
    • Trauma
    • May occur as an isolated condition but is seen more frequently in association with damage to the ipsilateral hip joint, mechanical back strain and obesity
      • The alteration in gait secondary to these conditions is accompanied by a limitation of internal rotation of the hip and reflex tightening of the external rotators, which may increase the tension of the iliotibial band and potentiate bursal inflammation
  • Conditions associated with trochanteric bursitis
      • Ipsilateral or contralateral hip arthritis inflam or degenerative
      • Degenerative arthritis/disc of the lower lumbar spine
      • Degenerative knee disease
      • leg length discrepancy
      • Residual weakness of hip after hip or disc operation
      • Hemiparesis, radiculopathy
      • Obesity
      • Fibromyalgia
      • Iliotibial band syndrome
      • Lower limb amputation
      • Pes planus
      • Tendonitis of the external rotators of the hip
  • Investigations
    • Slight irregularities of the GT or peritrochanteric calcifications of the bursa sometimes seen on plain radiographs
    • Isotope bone scans occasional increased uptake
  • Typical course
    • Acute phase may last several days
    • May have low grade symptoms for weeks/months
  • Treatment
  • Treatment
    • Rest
    • NSAIDs and physiotherapy
    • Ultrasound
    • Steroid injection
    • Surgical intervention
  • Treatment
    • First half century most pts treated conservatively
    • 1930s radiation treatment
    • 1950s steroid injections