Hip bursitis

Trochanteric hip bursitis treatment

Definition

Hip bursitis is also known as trochanteric bursitis. A painful inflammation of the bursa which separates the greater trochanter of the femur and the muscles and tendons of the thighs and buttocks. However many well regarded studies prove that there is no inflammation in patients with hip bursitis.

The scientific consensus concluded that patients presenting with symptoms of what used to be known as trochanteric hip bursitis should be called greater trochanteric pain syndrome (GTPS).

SO WHY

HIP BURSITIS

IS NO LONGER

CALLED AS SUCH?

Based on literature review of recent studies only 15% of patients with pain and tenderness around lateral hip had one of the hip bursas inflamed. Over 70% of patients with lateral hip pain had some kind of abnormalities in tendons attaching to greater trochanter (lateral hip bone). Some patients also had coxa sultans (snapping hip).

Research doctors concluded that the evidence showed inflammatory etiology (causation) is too weak. The current belief is that the etiology in GTPS is of degenerative overuse nature with secondary involvement in bursal tissue.

The most common activity associated with trochanteric bursitis is running and jumping. Patients usually complain of lateral hip pain even though the hip joint is not involved in this ailment. The trademark of trochanteric bursitis is tenderness over the greater trochanter.

Anatomy

A bursa is a small fluid-filled sac that reduces friction between bone and soft tissue
The hip abductor muscles (gluteus maximus, gluteus medius and gluteus minimus)

A bursa is a small fluid-filled sac that reduces friction between bone and soft tissue. In the case of a patient suffering from trochanteric bursitis- there is an increase of friction causing inflammation in the bursa between the muscles (gluteus medius), tendons, and bones.

The hip abductor muscles (gluteus maximus, gluteus medius and gluteus minimus) are the main stabilizers of the hip joint during weight bearing. Their relative tendons as well as TFL and IT band attach to different facets (bony attachment surfaces) of the lateral femur.

ETIOLOGY

Variety of abnormalities of hip muscle tendons attaching to the greater trochanter such as tendinopathy and/or snapping tendons are the main stake of this pathology.

FUNCTIONAL
PATHOLOGY

  • Hip and pelvic instability
  • Poor adductor /abductor balance
  • Abnormal weight shifting
  • Compensatory weight distribution imbalance

Incidence and Prevalence:

GTPS is a condition prevalent in middle-aged women, people suffering from low back pain and middle age runners.

Statistic data shows
10-20%
incidence in this population

Risk Factors:

  • Work or play activities that causes overuse
  • Stress on soft tissues
  • Gout
  • Rheumatoid arthritis
  • Previous surgeries
  • Playing sports
  • Poor posture
  • Poor weight bearing
  • Short leg syndrome
  • Low back pain

Diagnosis

Clinical history and proper examination is usually sufficient, however diagnostic ultrasonography or an MRI is very accurate and preferred in determining the stage and extent of GTPS.

Prognosis

According to research, individuals responded to treatment very well and within the first 6 months.

TREATMENT at NYDNRehab

At NYDNRehab we have extensive experience treating Trochanteric bursitis. Based on sonographic and functional evaluation we create an individual treatment plan. Treatment options may very depending on type and stage of the bursitis, tendinopathy and may involve: combination of manual therapy, ESWT (extracorporeal shock wave therapy), physical therapy exercises to eliminate hip muscle imbalance, hip pelvic instability and normalize weight bearing distribution.

We use our unique C.A.R.E.N (computer assisted rehabilitation environment) technology to retrain symmetrical weight bearing and equalize weight shifting.

We also utilized our advanced Gait Analysis which can help in pinpointing the insufficiencies and deficits of hip movement which is crucial to assigning an individualized treatment plan.

How we treat
We use our unique C.A.R.E.N (computer assisted rehabilitation environment)

How we treat

Testimonial

Greater Trochanteric Pain Syndrome

Greater trochanteric pain syndrome (GTPS) is a condition that was formerly known as trochanteric bursitis. Bursa are fluid-filled sacs located in your joints that prevent friction between your bones and soft tissues as you move. In your hip, a bursa is positioned to separate the trochanter of your hip — the “ball” of your hip ball and socket joint — from the tendons and muscles of your upper thigh and buttocks.

In the past it was thought that the bursa itself becomes irritated and inflamed, causing hip pain and discomfort. However, recent research has revealed that hip pain at the trochanter is not cause by an inflamed bursa, but rather by inflammation of the tendons that attach muscles to the hip joint.

Symptoms of GTPS

GTPS is marked by pain and tenderness at the side of the hip that becomes worse while standing, and during physical activities like walking, running and jumping.

Causes of GTPS

Degenerative repetitive overuse is the primary cause of GTPS. The syndrome is most commonly seen in middle aged runners, middle aged females, and patients suffering from low back pain.

Other causes include:

  • Instability of the hip and pelvis
  • Imbalance between abductor and adductor muscles
  • Abnormal weight bearing while standing and walking
  • Faulty running gait mechanics
  • Poor physical conditioning
  • Poor posture
  • Unequal leg lengths

Diagnosis

A health history and physical exam are often sufficient to diagnose GTPS. However, real-time diagnostic ultrasound can be useful in confirming diagnosis, and in determining the severity of GTPS.

Treatment at NYDNRehab

The hip pain specialists at NYDNR treat each patient individually, based on their unique needs. We use innovative treatment approaches and state-or-the-art technologies to diagnose and treat GTPS.

Treatment strategies may include:

  • ESWT (extracorporeal shock wave therapy) to accelerate healing
  • Physical therapy to improve muscle balance
  • Gait analysis and retraining to correct motor deficiencies at the hip joint
  • DNS (dynamic neuromuscular stabilization) to restore optimal movement patterns
  • C.A.R.E.N (computer assisted rehabilitation environment) to promote symmetrical weight bearing

At NYDNR, our goal is to get to the source of your pain and eliminate it, so you can enjoy normal healthy hip joint function.

 

130 West 42 Street Suite 1055, New York NY 10036
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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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