Hip Trochanteric Bursitis

Trochanteric bursitis is an inflammation of the bursa sac that lies over the hip joint.
The irritation is caused by friction from the wide band of tissue that passes over the
outside of the hip joint.

Symptoms:

• Onset of symptoms is gradual.
• Pain is felt over the bony prominence on the outside of the hip (at the top of the outside of the thigh).
• The pain is especially acute when attempting hip abduction (moving the leg away from the body in a sideways direction.)
  Sometimes snapping is felt over the joint.
• The athlete may walk with a limp.
• As the condition worsens, pain may begin to radiate down the thigh, especially when sleeping.
• In its most severe manifestation, adhesions that develop within the bursa may create a creaking sound (crepitus) when the hip is used. These adhesions may be felt as a series of tiny bumps between the skin and bone.

Causes:

• Repetitive contraction of the muscles over the hip, as in running.
• The condition is caused by friction of the wide band of muscles that passes over the bursa on top of the hip joint. However, the likelihood of this condition is increased if the athlete has one or more of several anatomical abnormalities, including a wide pelvis (which explains why this condition is seen more often in females), excessive pronation of the foot when running, and differences in leg length.

Athletes at Risk:

• Primarily runners.

Concerns:

• This condition rarely evolves by itself, so it is extremely important to seek medical attention.

What you can do:

• Cease the activity that causes the condition.
• Use ice to reduce inflammation (ice massage is especially effective).
• Seek medical attention.

Medication:

• For relief of minor to moderate pain, take acetaminophen as directed on label, or, for the relief of pain and inflammation, ibuprofen or aspirin if tolerated.  

What the doctor can do:

• Usually treatment for this condition is non-surgical.
• The doctor may prescribe anti-inflammatories and /or administer a cortisone injection.
• If the condition is caused by excessive foot pronation, prescribe inserts.
• Refer the athlete to a physical therapist for exercises to reduce the tightness in the muscles over the hip.

• If the condition has been allowed to become severe, surgical intervention may be necessary:

• The doctor enters the joint and removes the adhesions that have developed.
• Usually, the bursa sac is removed at the same time.
• A release of the iliotibial band is done in which the tissue is cut open so it does not rub the bursa.

• Rehabilitation should focus on strengthening the gluteal muscles and developing flexibility in the iliotibial band.

Recovery time:

• Without surgery: four to six weeks (some people may take much longer to recover)

Reprinted with permission from The Sports Medicine Bible (HarperCollins), by Dr. Lyle J. Micheli, former President of the American College of Sports Medicine