Trochanteric bursitis / Greater Trochanteric Pain Syndrome (GTPS)
What is Trochanteric bursitis?
A bursa is a thin-walled sac filled with a very small amount of fluid that is usually found over bony prominences and functions to help soft tissues to glide over these prominences.
The trochanteric bursa lies over the bony greater trochanter in the upper outer thigh. Trochanteric bursitis, sometimes called greater trochanteric pain syndrome, causes pain in this region that can vary from mild pain to disabling pain that requires the use of crutches to walk.
It can be caused by a number of things. Anything that causes an alteration in the way that a person walks can cause the condition. This includes anything that causes a limp, such as a foot injury, foot surgery, knee problems etc. It can also be caused by a fall directly onto the greater trochanter. As an overuse injury it can also occur in runners and other sports-active people. It can also occur in people who have had hip surgery, for example a hip replacement.
The condition can occur in association with iliotibial band (ITB) syndrome, where pain is felt along the outer thigh sometimes extending right to the outer aspect of the knee. The pain occurs along the path of the fibrous iliotibial band which is a structure that is important in knee movements.
How is it diagnosed?
Symptoms are often confused with those of hip arthritis, but diagnosis by a specialist is usually straightforward. It is important to exclude other problems which give similar symptoms. X-rays are usually performed to exclude some other possible hip problems.
How is Trochanteric bursitis treated?
Treatment starts with simple measures, and these are often effective. Rest, icing, anti-inflammatory tablets and painkillers can help symptoms.
Physiotherapy exercises, stretches and strengthening can also help. In cases that follow total hip replacement surgery, however, such exercises cannot be safely performed.
Sometimes the condition does not respond to these simple measures and then other treatments are considered. A steroid injection can be performed and often helps the pain, but not in every case. When the injection does help, the effect often wears off after 3-6 weeks and the pain returns.
Again, patients who have had a total hip replacement may not be considered for a steroid injection due to the small risk of infection in the soft tissues and therefore of the replacement itself.
What if these don’t work?
Shock wave therapy is considered in cases that haven’t responded to the previously discussed measures and as a first line treatment for trochanteric bursitis in those who develop this condition after total hip replacement surgery. It results in a healing response that can cure the condition. It involves no needles, no anaesthetic and is performed in the out-patient clinic. It is also very safe in all cases. Our results in trochanteric bursitis cases show that 80-85% of people are successfully treated.
In the very few cases that do not respond to all these measures a PRP (platelet-rich plasma) injection can be successful. If these measures don’t help then surgery may be required. This is commonly performed through key-hole surgery.
I now have only slight discomfort
My condition made walking painful and was also made worse if I had been sitting in the same position for a while, for example, driving. I also had problems if I slept on my left side. This was extremely uncomfortable. I was referred for physiotherapy and when this gave me no results over aproximately a year I then had an injection into my left trochanteric bursa. This did not give relief for long.
I was then referred to the clinic. After the consultation some specific stretches and a course of shock wave therapy were recommended. I had three sessions of SWT treatment. The first was uncomfortable for a short time whilst it was happening. Following this it gave me a little relief. The second session was more painful. When the third session had finished I had minimal discomfort. I can now walk longer periods and have only slight discomfort when driving, not as acute as it was before at all. I would say to others that the treatment is a little uncomfortable but the benefits after the third session far outweighs the pain experienced.
Highly recommend to others, without hesitation
All walking resulted in excruciating, debilitating pain affecting every aspect of everyday and social life. I also sufffered from constant broken sleep caused by pressure when lying on the affected hip. Sleeping on my back was not an alternative due to spinal problems.
I dosed myself up with various strong pain-killers culminating in solpadol which in turn affected my stomach and digestion. I also underwent a course of acupuncture which helped to a certain extent – but alasgave no complete cure. This treatment was continuous until my PRP injection.
My personal experience wwhen undergoing PRP treatment was no different from normal injections. The entire procedure of extraction and preparation of the blood and reinfusion into my hip was approximately 30-40 minutes.
After the treatment I was exceedingly surprised at the quick relief obtained. The hip problem has not returned, my sleep pattern is no longer affected by the “greater trochanteric pain syndrome”. I am therefore, without exaggeration, able to truthfully describe the result of my PRP treatment as amazing – bordering miraculous!
I would recommend this treatment to others, without hesitation.
bursitis greatly improved
I developed trochanteric bursitis and had a couple of steroid injections that helped but not for long. I also had hip arthritis and had a successful hip replacement which allowed me to be much more active. Some time after the replacement the bursitis pain came back. I couldn’t sleep on my side. The pain didn’t go away even after some physiotherapy. I had the shock wave treatment and following the treatment the bursitis pain was greatly improved. My sleep was no longer disturbed because I could sleep on my side so the treatment has been a success!
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