What is trochanteric bursitis?
Trochanteric bursitis is the painful inflammation and swelling of the trochanteric bursa that is situated between the greater trochanter of the femur (the bony prominence on the outside of the hip) and the attachment points of the gluteus medius and minimus, two of the buttock muscles. A bursa is a small fluid filled sac that forms around joints in areas where there is a lot of friction between muscles, tendons and outcrops of bone. The bursae position themselves in between the tendon or muscle and the bone, buffering any friction from movement. To picture a bursa imagine it as a very small water filled balloon sitting in places where things rub against each other, like in between a tendon and bone to provide a soft smooth cushion for the tendon to pass over painlessly. The covering of the bursa also acts a lubricant and helps the movement of the tendon. It is estimated that there are over 150 bursae in your body all with the job of protecting joints and tendons from wear. All are very small and unnoticeable until they become swollen and painful with bursitis.
Why & when does trochanteric bursitis happen?
Trochanteric bursitis can be caused through injury or infection and can be triggered by certain health conditions. If bursitis develops as a result of injury, it will normally be due to repetitive strenuous activity, which encourages the gluteal muscles and their tendons (which attach to the greater trochanter of the hip) to tighten and shorten from overuse, like repetitive road running. Certain conditions like hip osteoarthritis or low back injuries can cause the gluteal muscles to tighten and trigger trochanteric bursitis. This puts more pressure over the bursa as the tendon rubs more tightly over it, causing iritation and triggering a painful inflammatory reaction (swelling). The risk of developing bursitis in this way is greater in those whose jobs or hobbies involve a lot of repetitive movements. Carpet fitters and gardeners who spend a lot of time kneeling and so are more at risk of bursitis in the knee and likewise runners have a greater likelihood of developing trochanteric bursitis. Bursitis can also be brought on by excessive pressure or direct impact trauma like banging your elbow or dropping on to your knees. Infection is a less common cause of bursitis and normally only occurs in people who have a weakened immune system from other health issues. The infection can work its way to the bursa from a cut close to the bursa that has become infected. In these cases the bursitis is termed as septic bursitis. Certain health conditions can also trigger the development of bursitis such as rheumatoid arthritis and gout amongst others.
What does trochanteric bursitis feel like?
The symptoms of bursitis vary depending on whether it is the result of injury, an underlying health condition or infection. From normal overuse and injury the pain is normally a constant dull ache or burning pain around the hip that is aggravated by any touch, pressure or movement of the hip joint. There will normally be notable swelling unless the bursa lies deep under the skin like in the hip or shoulder, in these cases swelling may not be visible. Movement of the hip will be stiff especially in the mornings and after any activity involving the hip. The hip pain will radiate down the side of the leg towards the knee and in some cases around into the groin and buttocks. All of these symptoms are experienced with septic bursitis with the addition of a high temperature of over 38ºC and feverish chills. The skin around the affected joint will also appear to be red and will feel incredibly warm to the touch.
In cases of septic bursitis it is important that you seek medical attention. With injury induced bursitis if symptoms are still persisting after two weeks then report to your GP.
How long does trochanteric bursitis take to heal?
The healing time frame of trochanteric bursitis can vary from 2 weeks to 8 weeks and in some cases even longer than that. It depends on the location or severity of the injury. For example if the bursitis happens near a joint that you can rest easily then the healing time will be greatly reduced on the other hand if it is in a joint that you use often like the hip then this perpetuates and flares the condition making healing more of a drawn out struggle.
How will trochanteric bursitis be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis but may be requested to check for any underlying health conditions that may have triggered the bursitis.
What treatment options are available for trochanteric bursitis?
Your GP may prescribe a short course of anti-inflammatory painkillers to reduce and control the painful inflammation that occurs and antibiotics in cases of septic bursitis. Applying a covered ice pack to the area after the initial injury may also significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. Try where possible, to avoid all aggravating movements and postures, however complete rest is not advisable as this can lead to weakness and further shortening of the muscle. Massage and manipulative therapies can help loosen the surrounding muscles and tendons of the affected joint, reducing the pressure over the bursa and allowing it to heal faster. If the bursitis is chronic and not responding to treatment, then your GP may refer you for a corticosteroid injection which will reduce the inflammation levels which will in-turn reduce the pain levels experienced. Corticosteroid injections can have varied results. Surgery is a rare option when it comes to bursitis but occasionally it may be necessary in extremely chronic cases or to drain an infected bursa.
The underlying cause of the bursitis must be identified to prevent further reoccurrences. Failure to eliminate the cause will ensure future flare ups and a poor and slow recovery. Future occurrences can be prevented with the use of stretches and strengthening exercises which will help prevent muscles from tightening up over the bursa, Pilates and yoga are very good for this providing the aggravating movements are avoided. Wearing joint supports such as knee pads or elbow supports may also reduce your likelihood of redeveloping bursitis.