Greater trochanteric pain syndrome, also known as trochanteric bursitis, is inflammation
of the trochanteric bursa, a part of the hip.
This bursa is at the top, outer side of the femur, between the insertion of the gluteus
medius and gluteus minimus muscles into the greater trochanter of the femur and the femoral
shaft.
It has the function, in common with other bursae, of working as a shock absorber and
as a lubricant for the movement of the muscles adjacent to it.
Occasionally, this bursa can become inflamed and clinically painful and tender.
This condition can be a manifestation of an injury, but sometimes arises for no obviously
definable cause.
The symptoms are pain in the hip region on walking, and tenderness over the upper part
of the femur, which may result in the inability to lie in comfort on the affected side.
More often the lateral hip pain is caused by disease of the gluteal tendons that secondarily
inflames the bursa.
This is most common in middle-aged women and is associated with a chronic and debilitating
pain which does not respond to conservative treatment.
Other causes of trochanteric bursitis include uneven leg length, iliotibial band syndrome,
and weakness of the hip abductor muscles.
Greater trochanteric pain syndrome can remain incorrectly diagnosed for years, because it
shares the same pattern of pain with many other musculoskeletal conditions.
Thus people with this condition may be labeled malingerers, or may undergo many ineffective
treatments due to misdiagnosis.
It may also coexist with low back pain, arthritis, and obesity.
Symptoms The primary symptom is hip pain, especially
hip pain on the outer side of the joint.
This pain may appear when the affected person is walking or lying down on that side.
Prevention Because wear on the hip joint traces to the
structures that support it, proper fitting shoes with adequate support are important
to preventing GTPS.
For someone who has flat feet, wearing proper orthotic inserts and replacing them as often
as recommended are also important preventive measures.
Strength in the core and legs is also important to posture, so physical training also helps
to prevent GTPS.
But it is equally important to avoid exercises that damage the hip.
Diagnosis A doctor may begin the diagnosis by asking
the patient to stand on one leg and then the other, while observing the effect on the position
of the hips.
Palpating the hip and leg may reveal the location of the pain, and range-of-motion tests can
help to identify its source.
X-rays, ultrasound and magnetic resonance imaging may reveal tears or swelling.
But often these imaging tests do not reveal any obvious abnormality in patients with documented
GTPS.
Treatment The primary treatment is rest.
This does not mean bed rest or immobilizing the area but avoiding actions which result
in aggravation of the pain.
Icing the joint may help.
A non-steroidal anti-inflammatory drug may relieve pain and reduce the inflammation.
If these are ineffective, the definitive treatment is steroid injection into the inflamed area.
Physical therapy to strengthen the hip muscles and stretch the iliotibial band can relieve
tension in the hip and reduce friction.
The use of point ultrasound may be helpful, and is undergoing clinical trials.
In extreme cases, where the pain does not improve after physical therapy, cortisone
shots, and anti-inflammatory medication, the inflamed bursa can be removed surgically.
The procedure is known as a bursectomy.
Tears in the muscles may also be repaired, and loose material from arthritic degeneration
of the hip removed.
The bursa is not required, so the main potential complication is potential reaction to anaesthetic.
The surgery can be performed arthroscopically and, consequently, on an outpatient basis.
Patients often have to use crutches for a few days following surgery up to a few weeks
for more involved procedures.
There are numerous case reports in which surgery has relieved GTPS, but its effectiveness is
not documented in clinical trials.
See also Snapping hip syndrome
References
External links About trochanteric bursitis surgery at Orthogate.com-Dead
Link