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Trochanteric Bursitis


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Trochanteric Bursitis

  1. 1. Trochanteric Bursitis
  2. 2. 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) <ul><ul><ul><li>The subgluteus maximus is the largest </li></ul></ul></ul><ul><ul><ul><ul><li>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 </li></ul></ul></ul></ul>
  3. 3. History <ul><ul><li>Deep aching pain sometimes associated with burning sensation on the lateral aspect of the hip and thigh </li></ul></ul><ul><ul><li>Pain increases with activity </li></ul></ul><ul><ul><li>Worse at night when lying on the affected side </li></ul></ul><ul><ul><li>Associated with a limp in 15% of cases </li></ul></ul>
  4. 4. Clinical features <ul><li>Tenderness on palpation of the area around the greater trochanter – may feel boggy in thin patients </li></ul><ul><li>Resisted abduction of the hip when the patient is lying on the opposite side may accentuate the pain </li></ul><ul><li>Movements of the hip usually normal </li></ul>
  5. 5. Differential diagnosis <ul><li>Hip disease </li></ul><ul><li>Referred lower back pain </li></ul><ul><li>Stress fracture </li></ul><ul><li>Local infection </li></ul><ul><li>Tumour/metastatic disease </li></ul>
  6. 6. Clinical criteria for the diagnosis of trochanteric bursitis 1985 Ege Rasmussen and Fano <ul><li>Aching pain in the lateral aspect of the hip </li></ul><ul><li>Distinct tenderness around the greater trochanter </li></ul><ul><li>Pain at the extreme of rotation, adb/adduction </li></ul><ul><li>Pain on forced hip abduction </li></ul><ul><li>Pseudoradiculopathy </li></ul><ul><ul><li>Diagnosis requires presence of the first two and one of the other three </li></ul></ul><ul><ul><li>Not been validated </li></ul></ul>
  7. 7. Clinical features <ul><li>More common in women </li></ul><ul><li>Trauma </li></ul><ul><li>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 </li></ul><ul><ul><li>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 </li></ul></ul>
  8. 8. Conditions associated with trochanteric bursitis <ul><ul><li>Ipsilateral or contralateral hip arthritis inflam or degenerative </li></ul></ul><ul><ul><li>Degenerative arthritis/disc of the lower lumbar spine </li></ul></ul><ul><ul><li>Degenerative knee disease </li></ul></ul><ul><ul><li>leg length discrepancy </li></ul></ul><ul><ul><li>Residual weakness of hip after hip or disc operation </li></ul></ul><ul><ul><li>Hemiparesis, radiculopathy </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Fibromyalgia </li></ul></ul><ul><ul><li>Iliotibial band syndrome </li></ul></ul><ul><ul><li>Lower limb amputation </li></ul></ul><ul><ul><li>Pes planus </li></ul></ul><ul><ul><li>Tendonitis of the external rotators of the hip </li></ul></ul>
  9. 9. Investigations <ul><li>Slight irregularities of the GT or peritrochanteric calcifications of the bursa sometimes seen on plain radiographs </li></ul><ul><li>Isotope bone scans occasional increased uptake </li></ul>
  10. 10. Typical course <ul><li>Acute phase may last several days </li></ul><ul><li>May have low grade symptoms for weeks/months </li></ul>
  11. 11. Treatment
  12. 12. Treatment <ul><li>Rest </li></ul><ul><li>NSAIDs and physiotherapy </li></ul><ul><li>Ultrasound </li></ul><ul><li>Steroid injection </li></ul><ul><li>Surgical intervention </li></ul>
  13. 13. Treatment <ul><li>First half century most pts treated conservatively </li></ul><ul><li>1930s radiation treatment </li></ul><ul><li>1950s steroid injections </li></ul>