Abstract
Trochanteric bursitis is commonly encountered in clinical practice. Patients suffering from trochanteric bursitis frequently complain of pain in the lateral hip that radiates down the leg and mimics sciatica. The pain is localized to the area over the trochanter. Often, patients are 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. Patients may note that walking upstairs is becoming increasingly difficult. Trochanteric bursitis often coexists with arthritis of the hip, back and sacroiliac joint disease, and gait disturbance is often a contributing factor.
Keywords
trochanteric bursitis, hip pain, resisted abduction release test, Trendelenberg gait, arthritis, tendinitis, calcific tendinitis, diagnostic sonography, ultrasound guided procedure, septic bursitis, rice body
ICD-10 CODE M70.60
Keywords
trochanteric bursitis, hip pain, resisted abduction release test, Trendelenberg gait, arthritis, tendinitis, calcific tendinitis, diagnostic sonography, ultrasound guided procedure, septic bursitis, rice body
ICD-10 CODE M70.60
The Clinical Syndrome
Trochanteric bursitis is commonly encountered in clinical practice. Patients suffering from trochanteric bursitis frequently complain of pain in the lateral hip that radiates down the leg and mimics sciatica ( Fig. 104.1 ). The pain is localized to the area over the trochanter. Often, patients are 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. Patients may note that walking upstairs is becoming increasingly difficult. Trochanteric bursitis often coexists with arthritis of the hip, back and sacroiliac joint disease, and gait disturbance.
The trochanteric 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 loculated sacs. The trochanteric bursa is vulnerable to injury from both acute trauma and repeated microtrauma. Acute injuries may be caused by direct trauma to the bursa from falls onto the greater trochanter or previous hip surgery, as well as by overuse injuries, including running on soft or uneven surfaces. If inflammation of the trochanteric bursa becomes chronic, calcification may occur.
Signs and Symptoms
Physical examination reveals 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 reproduce the pain. Sudden release of resistance during this maneuver causes a marked increase in pain ( Fig. 104.2 ). No sensory deficit should be noted in the distribution of the lateral femoral cutaneous nerve; this feature distinguishes trochanteric bursitis from meralgia paresthetica. A Trendelenburg gait may be present ( Fig. 104.3 ).
Testing
Plain radiographs of the hip may reveal calcification of the bursa and associated structures, findings consistent with chronic inflammation ( Fig. 104.4 ). Magnetic resonance imaging is indicated if an occult mass or tumor of the hip or groin is suspected or to confirm the diagnosis ( Figs. 104.5 and 104.6 ). A complete blood count and erythrocyte sedimentation rate are useful if infection is suspected. Electromyography (EMG) can distinguish trochanteric bursitis from meralgia paresthetica and sciatica. The injection technique described later serves as both a diagnostic and a therapeutic maneuver.
