Injury Overview
Bursal tissue is present in the body to decrease friction between two adjacent moving structures. When this tissue becomes irritated (or inflammed), the condition is known as bursitis. The greater trochanter bursa lies between a tendon-like structure in the thigh known as the iliotibial band and a boney prominence in the thigh known as the greater trochanter. Greater trochanteric bursitis (sometimes referred to as trochanteric bursitis) can be caused by different things in all population types and may cause significant pain. Sometimes greater trochanteric bursitis is caused by changes in a person’s walking, running, or exercise mechanics. As we get older these mechanics change as our muscle bulk and posture change. In addition to changes in posture and mechanics, bursal tissue may also become inflammed in scenarios of overuse or mechanical irritation such as in the setting of external snapping hip syndrome. External snapping hip syndrome occurs when the iliotibial band continually snaps over the greater trochanter. This can occur if the iliotibial band is too tight or too thick.
Symptoms
Symptoms of trochanteric bursitis of the hip may vary from patient to patient. Often the main symptom is pain located on the outside portion of the thigh near the boney prominence of the greater trochanter. Often patients have trouble sleeping on their side and have reproducible discomfort with pushing on the greater trochanter. Pain may also occur when an individuals attempt to run or rotate their thigh/leg. Pain can also be present when one attempts to stand after a long period of sitting.
External snapping hip syndrome is marked by a popping sensation as a patient bends and straightens their hip. As patients flex their hip, the iliotibial band slides toward the front of the thigh over the greater trochanter. As patients extend their hip, the iliotibial band slides toward the back of the thigh over the greater trochanter. In patients with external snapping hip syndrome, this sliding is accompanied by an audible or palpable “pop” which can be painful. Sometimes, patients feel that this is a sign that their hip is popping into and out of joint. However, during this process the ball and socket of the hip joint remains as it should in place.
Diagnosis
Dr. Anz may first order X-rays to rule out other bony abnormalities that may be the source of pain or snapping. He will then obtain a history and perform an examination, including the patients’ discription of the pain/symptoms and a history of sports related injuries and activity. He will examine the lower extremities in order to see which movements cause discomfort and will also perform certain physical examination tests. In some scenarios, a MRI may be important in order to rule out other injuries or ensure a correct diagnosis. Relief of pain with an injection of an anesthetic into the bursa may also be used to confirm that bursitis is the primary source of pain.
Treatment
In most circumstances trochanteric bursitis does not require surgery. Injections in addition to physical therapy is often effective, especially when bursitis is caused by hip girdle weakness or changes in posture. There are four major stabilizers of the hip joint including the muscles of the hip girdle. Therapy focusing on pelvic girdle strengthening, core strengthening, and stretching of the ITB band can often make a significant improvement in mechanics and take pressure off of the bursa. Additionally, anti-inflammatory medications (taken by mouth or rubbed onto the region) and rest from aggravating activities can greatly benefit the patient and relieve associated symptoms.
Surgical
In rare cases, Dr. Anz may recommend surgical treatment. Surgery for the treatment of bursitis is most effective when a mechanical irritating force can be removed or an inciting mechanical scenario improved, such as in the setting of external snapping hip syndrome or femoroacetabular impingment. Dr. Anz will use an arthroscopic approach in order to remove the inflamed bursa and loosen the iliotibial band. During arthroscopic surgery, he will make keyhole incisions through which he will enter small surgical instruments and a camera. He will remove the inflamed bursa and lengthen the IT band in order to relieve pressure.
Post-Operative
Following arthroscopic surgery for trochanteric bursitis, Dr. Anz will prescribe a brief period of rest followed by a physical therapy program to help restore strength and motion. Patients often make great progress during physical therapy and can resume normal activities within 6 to 8 weeks.
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For more information on trochanteric bursitis of the hip, or if you have any other questions regarding surgical treatments for the hip, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.