eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Trochanteric Bursitis: Follow-up

Author: Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
Contributor Information and Disclosures

Updated: Oct 1, 2009

Follow-up

Further Outpatient Care

  • The patient should return for re-evaluation within approximately 1 month. Assess for a therapeutic response to the corticosteroid injection and to any other interventions (eg, PT) that have been initiated.
  • The patient should be instructed to contact the physician sooner than 1 month after the injection if there is significant progression of the symptoms or if there are any local signs of infection at the injection site.

Deterrence

  • Advise the patient to avoid lying on the affected side, if possible.

Complications

  • Progressive or persistent pain with associated limping and decreased mobility
  • Potential complications resulting from focal corticosteroid injection include the following:
    • Bleeding, bruising, infection, and allergic reactions may occur after the injection.
    • Necrotizing fasciitis has been observed from a single steroid injection of the greater trochanteric bursa.28
    • Transient elevation of blood glucose levels may occur after corticosteroid injection in a diabetic patient.
    • Local anesthetic injected intravascularly potentially could cause cardiac arrhythmia.
    • Subcutaneous skin atrophy can occur with more superficial administration of corticosteroids.
    • Peripheral nerve dysfunction is possible if the injection is administered very close to or within a major nerve.

Prognosis

  • Most patients with trochanteric bursitis respond very well to a combination of corticosteroid injection, PT, and activity restriction. Some patients may require a repeat of the corticosteroid injection.
  • A retrospective study of 164 patients who presented with trochanteric pain found that after 1 year, at least 36% were still symptomatic, and that after 5 years, 29% were still symptomatic; thus, many patients developed chronic pain at this site. Patients with osteoarthritis (OA) in the lower limbs had a 4.8-fold risk of persistent symptoms after 1 year, as compared with patients without OA. Patients treated with corticosteroid injection were 2.7 times less likely to have chronic pain at this site at 5 years, as compared with those treated without such injections.8

Patient Education

  • As with any medical condition, the patient should be educated with regard to the nature of the condition, causative factors, and treatment plan.
  • As with any injection, the patient should be educated to watch for any signs or symptoms of local infection at the injection site.
  • As with any corticosteroid injection, diabetic patients should be instructed that they may experience a transient increase in their blood glucose levels.
  • Additionally, as with any corticosteroid injection, patients should be informed that the symptomatic improvement from the corticosteroid usually does not begin to take effect until a few days after the injection. Patients should also understand that they may experience a mild, transient increase in symptoms during the window of time in which the local anesthetic has worn off but the steroids have not yet begun to have a therapeutic effect.

For excellent patient education resources, visit eMedicine's Arthritis Center. Also, see eMedicine's patient education article Bursitis.

Miscellaneous

Medicolegal Pitfalls

  • Never inject corticosteroid into a site that appears to be infected.
  • In the presence of significant trauma, always check the radiograph for evidence of fracture before proceeding with treatment.
  • If it is thought that the pain may be secondary to metastatic cancer, consider performing a bone scan, even if the plain radiograph findings are negative.11

Special Concerns

  • Pregnancy - A focal corticosteroid injection can be performed during pregnancy. Oral NSAIDs should be avoided, especially in the third trimester.
  • Pediatric population - For a patient who is a minor, obtain informed consent from the parent or legal guardian before proceeding with any injection.
  • Geriatric population - The physician should use caution when administering oral NSAIDs to elderly patients.
 
Acknowledgments

Debra Ibrahim, 4th year medical student, New York College of Osteopathic Medicine, Class of 2008, assisted with the revision of this manuscript.

Evish Kamrava, 4th year medical student, St. George's University School of Medicine, Class of 2009, assisted with the 2008 revision of this manuscript.

Jason Lee, 4th year medical student, St. George's University School of Medicine, Class of 2010, assisted with the 2009 revision of this manuscript.



More on Trochanteric Bursitis

Overview: Trochanteric Bursitis
Differential Diagnoses & Workup: Trochanteric Bursitis
Treatment & Medication: Trochanteric Bursitis
Follow-up: Trochanteric Bursitis
Multimedia: Trochanteric Bursitis
References
Further Reading
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References

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  4. Trochanteric bursitis. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:299-303.

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  12. Crespo M, Pigrau C, Flores X, et al. Tuberculous trochanteric bursitis: report of 5 cases and literature review. Scand J Infect Dis. 2004;36(8):552-8. [Medline].

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Further Reading

Related eMedicine topics:
Bursitis [Emergency Medicine]
Bursitis [Orthopedic Surgery]
Snapping Hip Syndrome
The Approach to the Painful Joint

Clinical trials:
Steroid Injection for the Treatment of Greater Trochanteric Pain Syndrome

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Keywords

trochanteric bursitis, bursitis, trochanter, bursitis hip, greater trochanteric bursitis, bursitis injection, trochanteric injection, greater trochanteric pain syndrome, extra-articular snapping hip syndrome, external snapping hip syndrome, painful inflammation of the bursa, lateral hip pain, repetitive contracture of gluteus medius, repetitive contracture of the iliotibial band

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Contributor Information and Disclosures

Author

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

Coauthor(s)

Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Rajesh R Yadav, MD, Assistant Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas at Houston
Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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