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Cascade Orthopaedics Practice Newsletter |
Thanks for being a patient of Cascade Orthopaedics! While many patients visit us for a specific problem, they or their loved ones often have other unrelated orthopaedic concerns. We are producing a monthly newsletter with the intent to provide a source of information and to serve as an educational resource for our patients on some common problems, and give advice on maintaining musculoskeletal health. Our goal is to help you prevent problems, and recognize what conditions might be causing pain and disability. We may also suggest resources that might be available to help you prevent or manage problems. Cascade's Website
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OUTER HIP PAIN - YOU MAY HAVE BURSITIS
One of the more common causes of pain over the outer part of the hip is bursitis. More specifically, trochanteric bursitis. Bursitis is painful inflammation of bursa. Bursae are fluid-filled sacs that act as cushion between muscles/tendons and the underlying bones and they are found in numerous places throughout the body. The bursa that sits on the top of the greater trochanter (part of thigh bone that sticks out in the outer part of the hip) is called trochanteric bursa. As with any other bursae in the body, the trochanteric bursa can get inflamed or irritated and cause pain, resulting in trochanteric bursitis.
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ANATOMY OVERVIEW:
 As mentioned in the introduction, trochanteric bursa sits right over the greater trochanter. Tendons of the buttock muscles (the gluteus medius and gluteus minimus are collectively called hip abductors) insert onto the bone in the vicinity of the trochanteric bursa. There is also ITB (iliotibial tract band), a band of connective tissue, that runs by the bursa and down the outside of the thigh.
As seen in the above illustration, the bursa is located well away from the hip joint. Hence, trochanteric bursitis does not involve the hip joint, although hip joint issues (e.g. osteoarthritis) can often coexist with bursitis.
WHAT ARE THE TYPICAL SYMPTOMS?
Patients typically complain of pain over the outer hip region or the outer area of the uppermost portion of the thigh. The pain is aggravated by certain activities, most commonly side-lying on the side of pain. Other aggravating activities may include running, stairs, sometimes even level-surface walking. The pain may spread to some extent down the outer thigh, although it generally does not go past the knee. When the pain shoots all the way down to the ankle or the foot, pinched nerve in the lower back is the more likely scenario.
WHAT CAUSES TROCHANTERIC BURSITIS?
Acute trauma such as a direct hard fall onto the greater trochanter and, more commonly, repetitive trauma such as habitual side-lying can cause bursitis. Trochanteric bursitis very often goes hand in hand with tendinopathy (tendon problem) of hip abductor muscles. Gluteal tendinopathy can be brought on by overtraining, running on uneven surfaces and leg length discrepancy. Other conditions that commonly trigger, or coexist with, bursitis include hip joint arthritis, postsurgical hip, sacroiliac joint problem and ITB syndrome.
TREATMENT:
Non-invasive treatments:
Activity modification, ice and NSAID's (non-steroidal anti-inflammatory drugs) are fundamental to the initial treatment of bursitis in the acute stage. Activity modification varies among patients, but all patients are universally suggested to refrain from lying on the side of pain. Depending on the cause of bursitis, other considerations may include temporarily suspending sports participation, limiting use of stairs and correcting abnormal body mechanics such as leg length difference. NSAID's are the most-commonly used pain reliever for bursitis, and it may be oral or topical. However not everyone can use NSAID's. For example, pregnant women, patients with kidney/liver impairment and those with serious cardiovascular issues should avoid NSAID use. Some patients may benefit from doing physical therapy to develop an appropriate exercise program to stretch and strengthen nearby muscles.
Cortisone injections:
Patients with severe acute bursitis pain or persistent subacute/chronic bursitis pain that does not go away with non-invasive treatments will usually need cortisone injections to the greater trochanteric bursae. Fortunately, injections result in significant pain relief most of the time, if directed to the precise location. Often, a single cortisone injection can lead to indefinite pain improvement or resolution. In some cases, a repeat injection may be considered if the pain recurs down the road. However, excessive number of repeat cortisone injections should be avoided, because of potential damage to nearby tissues.
Platelet-rich plasma therapy (PRP):
PRP is a relatively new injection therapy that is worth considering for any patient who experiences repetitive recurrences or persistence of pain despite repeated cortisone injections. In these patients, it is often the case that the injury to the hip abuctor tendons (ie, tendinosis) may be what is keeping the pain around, despite reducing the bursitis inflammation. The procedure involves drawing your own blood, then using a machine to extract PRP, which is a high concentrate of platelets. Your PRP is then injected into your injured hip abductor tendons adjacent to the bursa. Unlike cortisone injections which reduce inflammation, PRP promotes inflammation. But how does that help with the tendinosis and pain? Inflammation may give off a negative connotation, but it is actually the body's way of repairing soft tissue injuries. During inflammation, various growth factors come to the injured tissue site to locally promote blood flow and collagen production, ultimately leading to regeneration of the injured tissue. When PRP is injected into the injured tendon, it helps kick-start and boost this regenerative, healing process. It should be noted that most insurance plans do not cover PRP at this time.
Surgery:
Surgery is considered in cases where the pain does not respond to any of the above measures. However, the need for surgery is rare. It is generally an outpatient procedure in which the bursa is essentially removed.
WE CAN HELP
While trochanteric bursitis is fairly common, there are other conditions that can mimic it or coexist with it. Understanding the root cause of the bursitis and knowing how to prevent its recurrence are important. At Cascade Orthopaedics, we have experienced, fellowship-trained doctors who will accurately diagnose and treat bursitis pain so that you can get on with your life. Please call us at 253-833-7750 for further information or schedule an appointment with one of our specialists.
This material presented is for educational and informational purposes only. You should consult a physician or health care provider for actual evaluation, diagnosis, and individual treatment recommendations or advice.
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