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Trochanteric Bursitis

From Physiopedia

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Original Editors - Emy Van Rode

Top Contributors -

Emy Van Rode, Andrea Nees and Rachael Lowe  

Contents

Search Strategy

Databases

  • Pubmed
  • Web of Knowledge
  • Google scholar
  • Medscape

Search words

  • Hip bursitis
  • Trochanteric Bursitis
  • Greater trochanteric pain syndrome

Definition/Description

For the definition of bursitis: Bursitis.
There are 4 different types of hip bursitis: Trochanteric bursitis, iliopsoas bursitis, gluteal bursitis and ischial bursitis. Trochanteric bursitis is more common. The term greater trochanteric pain syndrome is now often substituted for trochanteric bursitis.[2] The condition is more prevalent in women than men. [3] (level of evidence A1)
• In this article, the condition trochanteric bursitis will be treated
 


Clinically Relevant Anatomy

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Epidemiology /Etiology

There are many factores that may cause greater trochanter pain syndrome:
- Dysfunction of the insertion of gluteus medius
- Hip osteoarthritis
- Lumbar spondylosis
- Excessive or rapidly increased mileage
- Frequent training on hard or banked running surface
- Poorly cushioned shoes
- Excessive pronation
- Leg length differences
- ITBS
[10]

Characteristics/Clinical Presentation

Following characteristics may occur:
- Chronic pain and/or hip tenderness in the lateral aspect of the hip
      More specifically while palpaiting superior and posterior of the greater trochanter.
      Maximum tenderness at the insertion of the M. Gluteus maximus
      Can also be felt over the iliotibial tract [4]
- Pain limits the strength and makes the legs feel weak
- Pain while walking or running, in the area of the greater trochanter and can be felt over the lateral aspect of the leg until the knee
- Stair-climbing is most painful [11]
- Patient is not able to lie down on the affected side
      Development of pain-related sleep disturbance [2]
- Lower back pain can be related to Trochanteric Bursitis [6]
- Weakness of the hip-abductors
      Resistance test can cause and tenderness
- Pain and tenderness can perform while resisting external rotation
- A snap felt in the lateral aspect of the hip [1] (level of evidence A1)

Differential Diagnosis

Trochanteric bursitis is one of the pathologies that can cause lateral hip pain. The other pathologies that are involved could be:

  • Gluteal tendonitis
  • Gluteal muscle dysfunction (atrophy, tear,…)
  • Iliotibial band disorders (_Snapping_Hip syndrome)
  • Femoral_Fractures (Femoral neck stress fractur)
  • Lumbar spine disease and ipsilateral hip pain.

[6],[7](level of evidence A1)

Diagnostic Procedures

• Gluteus medius tendonitis [3]
• Iliotibial band disorders (_Snapping_Hip):
Confirmed with positive Ober's_Test. [6]
• Gluteal medius muscle disfunction :
Confirmed with positive Trendelenburg_Test. Tenderness involving the whole muscle instead of point tenderness. A tear of the muscle can be revealed with an MRI.[7]

 Iliotibial band disorders, Gluteal muscle atrophy and hip tendonitis are hard to differentiate with a trochanteric bursitis because they could be in relation with, or even be the cause of this disorder. For instance, while testing for Iliotibial band disorders or gluteal muscle atrophy, symptoms will also occur when suffering from a bursitis. MRI must give more specific information. [6]

• Femoral neck stressfracture:
The hop test on one leg will cause pain in the ipsilateral groin region in case of a femoral neck stressfracture. [1]
• Lumbar spine disease and ipsilateral hip pain :
Differentiated with the FABER_Test  [1]
(level of evidence A1)

Outcome Measures

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Physical Examination

The first part of the physical examination is to observe the person’s gait for abnormalities like asymmetry of the waist and hips, a favored side while walking. Further, an examination of the hip is important to establish any limitations or deficits that the patient may have. It is possible that there is an underlying disorder or anatomical impairment present that may cause a bursitis or tendonitis. A weakness of the Mm. Gluteï, a unilateral tilt of the pelvis because of a leg length difference and lumbar spine disorders like scoliosis could be responsible for a bursitis or tendonitis. [1] (level of evidence A1)

An examination of the lumbar spine and knee is also required when the patient complains about pain in this area’s. This pain can refer to the patient’s hip pain. In general, it is important to observe, to palpate, to check the range of motion and to test the strength of the muscles and other anatomic structures that are involved in this issue. The range of motion can be checked with several tests: The faber test, trendelenbrug test, Ober’s test, Thomas test [1] and the snapping hip maneuver could be helpful in diagnosing the cause of lateral hip pain.[6]

Medical Management

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Physical Therapy Management

Physical therapy is given to improve flexibility, muscle strengthening and joint mechanics. When these aspects are improved, pain will decrease. [4] The therapy consists of stretching the M. Tensor fasciae latae and the Iliotibial band because these aspects are often shortened and causes an increased friction with the bursa. [1] Iliotibal band syndrome can be confirmed with a positive Ober’s test.[6] When physical examination shows weakness of the hip abductors, the physical therapist must give exercises for strengthening the hip abductors. Weakness of these group of muscles can be noticed while testing the patient on trendelenbrug gait. Other physical therapy interventions are the use of ultrasound, moist heat, patient education regarding activity modification and correcting possible training errors. [3]

To heal trochanteric bursitis it is necessary to proceed to infiltration of the bursa with antiphlogistic medication (Corticosteroid-injections). In case of a persistent bursitis surgery has to be considered as well. [8]

(levels of evidence A1, C)

Key Research

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

• Pubmed
• Medscape
• Web of Knowledge
• Google scolar
• Book: Meeusen R. Heup- en liesletsels, reeks sportrevalidatie. 90-5583-724-5, 2000.

Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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1. J. Rosenberg, R. Patel. Hip tendonitis and bursitis review. http://emedicine.medscape.com/article/87169-overview. Level of evidence: 1 (A1)

2. Patrick M Foye, MD, Todd P Stitik, MD. Trochanteric bursitis review. http://emedicine.medscape.com/article/87788-overview Level of evidence: 1 (A1)

3. Kyndall L. Boyle, MS, Shane Jansa, MS, Chad Lauseng, MS, Cynthia Lewis. Management of a Woman Diagnosed with Trochanteric Bursitis with the Use of a Protonics® Neuromuscular System. Journal of the Section on Women’s Health, volume 27, No.1, March 2003

4. Bryan S. Williams, Steven P. Cohen: Greater Trochanteric Pain Syndrome: A Review of Anatomy, Diagnosis and Treatment. ANESTHESIA & ANALGESIA, Vol. 108, No. 5, May 2009
Level of evidence: 1 (A1)

5. Dina L. Jones, Diagnosis of Trochanteric Bursitis Versus Femoral Neck Stress Fracture, case report. Physical Therapy. Volume 77. No 1. January 1997

6. Katherine Margo, MD, Jonathan Drezner, MD, and Daphne Motzkin, MD. Evaluation and management of hip pain: An algorithmic approach. The journal of family practice, vol 52, No 8, august 2003.

7. M. Lequesne, P. Mathieu, V. vuillemin-Bodaghi, H. Bard, P. Dijan. Gluteal Tendinopathy in Refractory Greater Trochanter Pain Syndrome: Diagnostic Value of Two Clinical Tests. Arthritis & Rheumatism, Vol. 59, No. 2, February 15, 2008, pp 241–246
Level of Evidence: 1 (A1)

8. Cohen S.P., Narvaez J.C., Lebovits A.H., Stojanovic M.P. Corticosteroid injections for trochanteric bursitis: is fluoroscopy necessary? A pilot study. British Journal of Anaesthesia volume 94 , No 1: 100–6, 2005
Level of Evidence: 3 (C)

9. Woodley S.J., Nicholson H.D., Livingstone V., Doyle T.C., Meikle G.R., Macintosh J.E., Mercer S.R. Lateral Hip Pain: Findings From Magnetic Resonance Imaging and Clinical Examination. Journal of orthopaedic & sports physical therapy, Vol 38, No. 6, June 2008, pp 313 - 328

10. Paluska S.A., An overview of Hip Injuries in Running. Sports Med 2005; 35, pp 991 – 1014

11. Ombregt L., Bisschop P., ter Veer H.J., Van de Velde T., A System of Orthopaedic Medicine. 1999.

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