Trochanteric Bursitis: Causes and Treatment

19 September, 2020
One of the main causes of hip pain is trochanteric bursitis, which is an inflammation of the bursa joint. Keep reading to find out more about what causes it and how to treat it. 

In an increasingly aging population, rheumatological problems are very common. One of these issues is hip pain, which can present complications in older people and should therefore be treated promptly. Statistically, the main cause of hip pain is trochanteric bursitis. Let’s talk about causes and treatment.

What is bursitis?

The term ‘bursitis’ refers to the inflammation of the bursa: a sort of membrane that covers the joints. In this case, it covers the femur’s greater trochanter, which connects to the acetabulum.

The hip joint is complex and that’s why it has three to four of these membranes that can swell when put under certain stress.

Causes of trochanteric bursitis

The membranes that make up the bursa joint can become inflamed by excessive friction with the trochanter or the hip joint during flexing and stretching. This can happen for several reasons, such as:

  • Obesity: being overweight produces a greater load over the joint. In these cases, blood circulation is more compressed and the bursa joint is more likely to suffer.
  • Rheumatological diseases such as spondyloarthritis, coxarthrosis, or herniated lumbar discs. These will cause postural overcompensation to reduce pain, which will result in more friction and deterioration of the bursae.
  • Lower limb dysmetria: if one of your legs is longer than the other, the posture imbalance will affect the bursa.
Hip pain: Trochanteric bursitis.

  • Flat feet: when there’s no arch in the sole of the foot, it affects the knees and the hip. One way it can affect the latter is precisely by the inflammation of bursae (bursitis).
  • Other problems such as weakness in the pericoxal muscles, the presence of a neurological problem such as hemiparesis, or diseases such as fibromyalgia, could cause trochanteric bursitis.

What to do when you suffer from trochanteric bursitis?

People with this condition usually have a dull pain in the hip as a result of the tension in the inflamed bursa, normally when sitting down, climbing stairs, walking, or lying on the bed. Since it happens while performing everyday activities, it can be quite annoying, which prompts the patient to visit the doctor and claim they have hip pain.

Diagnosis

The doctor must assess the symptoms to make a correct diagnosis, which is clinical in most cases, meaning that symptoms are enough to identify trochanteric bursitis and begin treatment. 

On other occasions, when the diagnosis is complex or the patient isn’t responding to treatment, the doctor might resort to a radiology exam. An X-ray may show calcifications in the bursa membrane, but this isn’t always the case. Other tests such as CT, ultrasound, or MRI scans can be prescribed, but they’re usually not very specific.

Treatment for trochanteric bursitis

Treatment usually involves medication, although on rare occasions it may require surgical intervention. Most patients respond to treatment with one or two injections of corticosteroids and anesthetics.

A male physiotherapist treating a male patient for trochanteric bursitis.

The injection’s solution involves a local anesthetic drug and a glucocorticoid, and it’s then administered on the painful area. Afterward, the patient will have to rest for two days and take an anti-inflammatory drug such as ibuprofen for one to two weeks.

When this treatment doesn’t improve the symptoms, the doctor may suggest a surgical procedure. However, the available options are based on little evidence and haven’t been researched enough.

One particular surgical option is the Ahern technique, which consists of an incision to remove the affected region. In most cases, it improves symptoms but it doesn’t completely solve the problem.

  1. Slawski DP, Howard RF. Surgical management of refractory trochanteric bursitis. Am J Sports Med. 1997;25(1):86–9.
  2. Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: A systematic review. Vol. 21, Clinical Journal of Sport Medicine. 2011. p. 447–53.
  3. Bursitis trocantérea [Internet]. [cited 2020 Jan 4]. Available from: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1131-57682003000100006