 |
|
|||||||||
Published on: Jun 21, 2006
Last modification: Jun 21, 2006
Hip Bursitis - Trochanteric Bursitis
by SirGan
 Hip bursitis is one very common problem that causes pain over the outside of the upper thigh. What exactly is a bursa? A bursa is a fluid filled sac that allows smooth motion between two uneven surfaces. This shouldn’t be misunderstood! There are hundreds of bursas in the human body, especially in the joints of the shoulder, hip, knee, and ankle. These small sacs of fluid cushion the places where tendons, ligaments, and muscles move over bones. The fact is that when this bursal sac becomes inflamed, each time the tendon has to move over the bone, it causes strong pain. Although trochanter bursitis usually affects middle-aged or elderly persons, women more often than men, it can develop in younger people also. Good thing about it is that trochanteric bursitis is a common cause of leg pain and the prognosis for recovery is very good. Most people with trochanteric bursitis respond very well to treatment.Incidence of the conditionTrochanteric bursitis is relatively common among both physically active and sedentary patients. It can also occur as a complication of arthroscopic surgery of the hip. The overall complication rate is estimated at 1.4%. The fact is that neither racial, sex nor age predilection has been reported.
Normal anatomy of the hip jointNot too many people know that the thighbone, the longest and strongest bone in the body, is known anatomically as the femur. Anatomically -there is a large protrusion at the top of this bone known as the femur head. This ball-shaped section of bone forms a ball-and-socket joint.
What exactly is trochanter? Well, the trochanter is palpable protrusion at the top of the femur, extending laterally in the direction of the hip. Because a number of muscles attach to this anatomical part- there are many bursas cushioning the sensitive interfaces between them and the bone.
Symptoms of hip bursitisThere are many symptoms that could be associated with this condition.
Possible causes of hip bursitisSeveral researches done in the past have proven that this bursitis is most often caused by repetitive, minor impact on the area, or from a sudden, more serious injury. It is more common in women and in middle-aged or elderly people. Bursitis typically results from one or more of these factors:
PathophysiologyWhat happens exactly? Well, the inflammation of the affected bursa between the femoral trochanteric process and the gluteus medius/iliotibial tract may be due either to acute or repetitive (cumulative) trauma. Acute trauma includes contusions from falls, contact sports, and other sources of impact. Repetitive trauma includes bursal irritation due to friction by the iliotibial band, which is an extension of the tensor fascia lata muscle. Such repetitive, cumulative irritation often occurs in runners but also can be seen in less active individuals. Other predisposing factors include leg length discrepancy, hip abductor weakness, and lateral hip surgery.
Differential diagnosisIt is proven that there are several other conditions that could mimic the symptoms of trochanter bursitis! Some of those are:
Arthritis is among the most frequent causes of hip pain.
Tendonitis can occur in any of the tendons that surround the hip joint.
This is one specific condition that occurs when blood flow to an area of bone is restricted. If an inadequate amount of blood flow reaches the bone, the cells will die and the bone may collapse.
Many back and spine problems can cause symptoms around the buttocks and hip. The most common problems that refer pain to the hip region are herniated discs and sciatica.
Snapping hip syndrome is characterized by band snapping over the outside of the thigh, deep hip flexor snapping over the front of the hip joint and tearing of the cartilage, or labrum, around the hip socket can cause a snapping sensation.
Strains of the muscles around the hip and pelvis can cause pain and spasm.
Hip fractures are most common in elderly patients with osteoporosis.
Diagnosis of trochanter bursitis
Disorders of the hip are diagnosed by direct physical examination. How it is being done? The patient is usually lying on his or her side or back and mild pressure is placed over the ridge of the greater trochanter. This maneuver usually elicits pain that becomes more powerful with external rotation of the hip. The doctor should also ask a patient about medical history, especially information concerning previous surgery involving the trochanter.
X-rays are often used, and many times calcium deposits or bony spurs are seen.
A rheumatological evaluation is also very important primary to rule out some other disorders, such as fibromyalgia. It may especially be necessary if the patient has a history of multiple tendon disorders such as shoulder bursitis or low back pain. Fibromyalgia is a common rheumatic syndrome that causes pain and weakness in the muscles.
Treatment of hip bursitis
There are many treatment options for this disorder and the choice of treatment depends entirely on the cause of the problem. That’s why, it is important that patient understand the cause of symptoms before embarking on a treatment program.
Sometimes non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed. These usually include ibuprofen or naproxen. They have the analgesic and as anti-inflammatory properties. They are very helpful because they decrease inflammation in the bursa and relieve pain.
Every doctor should recommend ice therapy to the area to decrease inflammation, especially after receiving the analgesic injections! In general, it is recommended that a petient apply a large ice pack on the affected area for 20 to 30 minutes.
Weight loss may be recommended if a patient is overweight because these extra pounds are putting the enormous pressure on the hips and knees!
Physical therapy includes range of motion exercises and splinting. Physical therapy can be incorporated to teach the patient a home exercise program, emphasizing stretching of the iliotibial bands, tensor fascia lata, external hip rotators, quadriceps, and hip flexors.
The first step in treatment of trochanteric bursitis should be simple rest. The most important thing for a patient is to identify the activities which cause or aggravate the problem, and to make modifications accordingly.
When the surgery should be performed? Well, there is no doubt- surgery is only advised as a last resort, only if an underlying cause has been elucidated and the treatment regimen fails to bring significant relief. The surgical procedure may consist of:
Prevention of bursitis
Prognosis of bursitisSeveral researches done in the past have proven that trochanteric bursitis which is caused by some other underlying conditions like arthritis or gout is more difficult to treat and may require many lifestyle adjustments. They are all based on only one purpose- avoiding the activities that seem to cause or aggravate the bursitis.
Unfortunately- the success rate for surgery still is not high. Patient must understand that successful long-term treatment for trochanteric bursitis could and must involve big efforts of the patient to change his or her style of life, occupation, or activities.
|
|
|
Article sources
|
