Trochanteric Bursitis

THE CLINICAL SYNDROME

Trochanteric bursitis is a commonly encountered pan complaint in clinical practice. The patient suffering from trochanteric bursitis will frequently complain of pain in the lateral hip that can radiate down the leg, mimicking sciatica. The pain is localized to the areas over the trochanter. Often, the patient will be unable to sleep on the affected hip and may complain of a sharp, catching sensation with range of motion of the hip, especially on first arising. The patient may note that walking upstairs is becoming increasingly more difficult. Tronchanteric bursitis often coexists with arthritis of the hip joint, back and sacroiliac joint disease, and gait disturbance.

The pain of trochanteric bursitis may often mimic sciatica.

The tronchanteric bursa lies between the greater trochanter and the tendon of the gluteus medius and the iliotibial tract. This bursa may exist as a single bursal sac or, in some patients, as a multisegmented series of sacs that may be loculated in nature. The trochanteric bursa is vulnerable to injury from both acute trauma and repeated microtrauma. Acute injuries frequently take the form of direct trauma to the bursa via falls directly onto the greater trochanteric or previous hip surgery as well as from overuse injuries, including running on soft or uneven surfaces. If the inflammation of the trochanteric bursa becomes chronic, calcification of the bursa may occur.

SIGNS AND SYMPTOMS

Physical examination of the patient suffering from trochanteric bursitis will reveal point tenderness in the lateral thigh just over the greater trochanter. Passive adduction and abduction as well as active resisted abduction of the affected lower extremity will reproduce the pain. Sudden release of resistance during this maneuver will markedly increase the pain. There should be no sensory deficit in the distribution of the lateral femoral cutaneous nerve as seen with meralgia paresthetica, which is often confused with trochanteric bursitis.

TREATMENT

A short course of conservative therapy consisting of simple analgesics, nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors is a reasonable first step in the treatment of patients suffering from trochanteric bursitis. The patient should be instructed to avoid repetitive activity that may be responsible for the development of trochanteric bursitis, such as running on sand. If the patient does not experience rapid improvement, the following injection technique is a reasonable next step. Injection of the tronchanteric bursa can be carried out by placing the patient in the lateral decubitus position with the affected side up. The mid point of the greater trochanter is identified. Tronchanteric bursitis frequently coexists with arthritis of the hip, which may require specific treatment to provide palliation of pain and return of function. This injection technique is extremely effective in the treatment of trochanteric bursitis.

Correct needle placemant for injection of the trochanteric bursa.

The use of physical modalities including local heat as well as gentle stretching exercises should be introduced several days after the patient undergoes this injection technique. Vigorous exercises should be avoided as they will exacerbate the patient’s symptomatology. Simple analgesics, nonsteroidal anti-inflammatory drugs, and antimyotonic agents may be used concurrently with this injection technique.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age –related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.