The trochanteric bursa rests between the greater trochanter and the iliotibial track. The bursa is a fluid filled sac, which helps lubricate ligaments around the greater trochanter bone. Inflammation of this bursa can cause excessive pain in the hip area during hip flexion and extension. Pain may radiate down the lateral leg as far as the ankle and simulate sciatica.
The greater trochanter, the bursa and the iliotibial track are located subcutaneously, and inflammation of the bursa can be caused by direct contusion to the area. This can be seen in contact sports, like football or ice hockey. Inflammation of the trochanteric bursa is also common in running sports. In these cases the bursitis is a result of excessive friction between the bony greater trochanter and the iliotibial track as they pass over each other during hip flexion and extension.
Patients usually complain of pain in the area over the lateral hip that may radiate distally to the knee or ankle (but not into the foot), or proximally into the buttock. The pain is worse when first rising from a seated or recumbent position, feels somewhat better after a few steps, and recurs after walking for half an hour or more. Patients may also report night pain and inability to lie on the affected side.
Point tenderness over the lateral greater trochanter is the essential finding. Tenderness above the trochanter suggests tendinitis of the gluteus medius tendon and may be associated with a positive Trendelenburgâ€™s sign and a limp. External rotation may be uncomfortable, but internal rotation of the hip should be normal.
Trochanteric bursitis can successfully be treated with ice, rest and NSAIDs. An iliotibial band-stretching program is very important, especially in the younger age groups. The most direct treatment is injection of a local anesthetic and corticosteroid preparation into the greater trochanteric bursa. The injection relieves symptoms successfully in more than 90% of patients. Occasionally, repeat injections are required for symptomatic relief. In severe cases, resection of the trochanteric bursa is required (very rare).
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