Trochanteric Hip Bursitis Treatment in NYC | NYDNRehab

Hip bursitis

Trochanteric hip bursitis treatment

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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

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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

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A clinical exam and diagnostic ultrasound imaging can help your therapist pinpoint the exactly which gluteal tendon and bursa is involved and what causes overuse of these structures.

Ultrasound enables you and your therapist to view the hip region in real time, while in motion. In addition to ultrasound, video gait analysis can help us identify faulty movement mechanics that contribute to hip and groin pain. Once the exact cause is determined, an effective treatment plan can be initiated.

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Please explore more advanced diagnostic option unavailable anywhere else:

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Hip dysfunction and pain can be a complex issue due to interactions of the trunk, pelvis, low back, groin and hip joint. Physical therapy and rehabilitation that is based only on subjective clinical analysis often addresses the symptoms without resolving the underlying cause.

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At NYDNRehab, our groundbreaking motion analysis technology and high resolution diagnostic ultrasonography have enabled us to develop a battery of tests that perfectly reveal the dynamic functional pathology of the hip joint and pelvis. Our tests are evidence-based protocols that are considered to be the gold standard in the world of research.

Our testing protocol includes:

1

Combined lumbopelvic hip stability test using DLEST methodology with C.A.R.E.N., our computer assisted rehab environment

2

Hip joint stability test using DLEST methodology with C.A.R.E.N.

3

3D star excursion banner test (SEBT) for assessing the involvement of the hip joint and muscles in postural stability

4

3D gait or running analysis

5

3D kinematic joint angle analysis during a squat, lunge, drop jump and pelvis on hip rotation

6

Rehabilitative ultrasonography for viewing intrinsic hip stabilizing muscle activation patterns

We also perform neuromotor testing with DD Robotech for:

  • Proprioception
  • Tracking ability
  • Force sense
  • Critical power
  • Reactive power
  • Flexibility

SEMG

Surface electromyography (SEMG) may be added to any of the above tests when needed.

Based on our experience and evidence-based information, we believe that physical therapy and rehabilitation should be based on objective quantifiable data.

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

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Regenerative Therapies are Game
Changers for Hip Bursitis

The human body has its own innate healing mechanisms, but it sometimes needs a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.


Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT is a fairly new technology that transmits high energy magnetic pulses to targeted tissues. The magnetic waves synchronize with the body’s own magnetic fields, causing a disturbance that triggers a regenerative response. EMTT waves can penetrate deep tissues up to 18 cm beneath the skin’s surface, to target difficult-to-reach tendons, muscles, bones and nerves.

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues. This speeds up the delivery of oxygen and nutrients to damaged tissues and stimulates cellular metabolism, to accelerate the healing process.


High Energy Inductive Therapy (HEIT)

HEIT uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes. HEIT generates a magnetic field 600 times stronger than the field of a normal magnet, to stimulate healing of nerves, muscles and blood vessels.

Regenerative Indiba

INDIBA CT9 Radiofrequency Device

INDIBA CT9 Radiofrequency Device

Our INDIBA Tecar therapy machine converts electrical current into a stable radio frequency current of 448 kHz, designed to increase and stabilize the exchange of ions in damaged cells, evoking a regenerative response that accelerates healing. INDIBA can be used to successfully treat joint and muscle disorders, low-back pain, sports injuries, surgical incisions and various pain syndromes. Another therapeutic effect of INDIBA is extreme and prolonged cellular hyperthermia. Due to this effect, INDIBA therapy combined with manual therapy and soft tissue tissue manipulation enables instantaneous release to occur, significantly shortening the number and duration of physical therapy sessions. What is normally accomplished in two months of physical therapy can be accomplished in 3-4 sessions with INDIBA.


Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to lower back pain. Dry needling is an outpatient procedure that inserts non-medicated needles into the trigger point to evoke a twitch response, releasing the trigger point and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing pain and discomfort for the patient.

Regenerative Ultrasound Guided Injection Therapies
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Ultrasound Guided Injection
Therapies

Injection therapies use natural/neutral solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.

Focused Shockwave Therapy

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels. PRP can help to jump-start healing in chronic injuries and accelerate repair in acute injuries.


Proliferation Therapy, aka Prolotherapy

Prolotherapy uses a biologically neutral solution, often containing dextrose, saline or lidocaine. The solution irritates the affected connective tissue, stimulating the body’s own natural healing mechanisms to encourage growth of new normal ligament or tendon fibers.

Electromagnetic Transduction Therapy (EMTT)
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 tocks.

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 muscles
  • Abnormal weight bearing while standing and walking
  • Faulty running gait mechanics
  • Poor physical conditioning
  • Poor posture
  • Unequal leg lengths

Diagnosis

A health histo diagnose GTPS. However, real-time diagnostic ultrasound can be useful in confirming diagnosis, and in determining the severity of GTPS.