Physical Medicine and Rehabilitation for Trochanteric Bursitis Follow-up

  • Author: Patrick M Foye, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Jan 18, 2012
 

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.
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Deterrence

  • Advise the patient to avoid lying on the affected side, if possible.
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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.[30]
    • 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.
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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]
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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.

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Contributor Information and Disclosures
Author

Patrick M Foye, MD  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 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, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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.

Dev Sinha, MD  Resident Physician, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Health Systems

Disclosure: Nothing to disclose.

Specialty Editor Board

Rajesh R Yadav, MD  Associate Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas Medical School 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, 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

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health 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.

Additional Contributors

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.

References

  1. Brinker MR, Miller MD. The adult hip. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:269-85.

  2. McGee DJ. Hip. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:333-71.

  3. Steinberg JG, Seybold EA. Hip and pelvis. In: Steinberg GG, Akins CM, Baran DT, eds. Orthopaedics in Primary Care. 3rd ed. Baltimore, Md: Lippincott, Williams & Wilkins; 1998:171-203.

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

  5. Silva F, Adams T, Feinstein J, et al. Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol. Apr 2008;14(2):82-6. [Medline].

  6. Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. In: Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:783-812.

  7. Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. Aug 2007;88(8):988-92. [Medline].

  8. Lievense A, Bierma-Zeinstra S, Schouten B, et al. Prognosis of trochanteric pain in primary care. Br J Gen Pract. Mar 2005;55(512):199-204. [Medline]. [Full Text].

  9. Clarke MT, Lee PT, Arora A, et al. Levels of metal ions after small- and large-diameter metal-on-metal hip arthroplasty. J Bone Joint Surg Br. Aug 2003;85(6):913-7. [Medline].

  10. Farmer KW, Jones LC, Brownson KE, et al. Trochanteric bursitis after total hip arthroplasty incidence and evaluation of response to treatment. J Arthroplasty. Mar 3 2009;[Medline].

  11. Bertoli AM, Saurit V, Alvarellos A, et al. Soft tissue metastases presenting as greater trochanteric pain syndrome. J Clin Rheumatol. Dec 2003;9(6):370-2. [Medline].

  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].

  13. Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. Dec 2008;24(12):1407-21. [Medline].

  14. Kong A, Van der Vliet A, Zadow S. MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome. Eur Radiol. Jul 2007;17(7):1772-83. [Medline].

  15. Blankenbaker DG, Ullrick SR, Davis KW, et al. Correlation of MRI findings with clinical findings of trochanteric pain syndrome. Skeletal Radiol. Oct 2008;37(10):903-9. [Medline].

  16. Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. Sep 2011;21(5):447-53. [Medline].

  17. Slawski DP, Howard RF. Surgical management of refractory trochanteric bursitis. Am J Sports Med. Jan-Feb 1997;25(1):86-9. [Medline].

  18. Baker CL Jr, Massie RV, Hurt WG, et al. Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy. Aug 2007;23(8):827-32. [Medline].

  19. Farr D, Selesnick H, Janecki C, et al. Arthroscopic bursectomy with concomitant iliotibial band release for the treatment of recalcitrant trochanteric bursitis. Arthroscopy. Aug 2007;23(8):905.e1-5. [Medline].

  20. Voos JE, Rudzki JR, Shindle MK, et al. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy. Nov 2007;23(11):1246.e1-5. [Medline].

  21. Fundamentals of procedural care. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:1-13.

  22. Nonsteroidal anti-inflammatory drugs (NSAIDs). In: Green SM, ed. Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Pub; 2000:11-2.

  23. Furia JP, Rompe JD, Maffulli N. Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. Am J Sports Med. Sep 2009;37(9):1806-13. [Medline].

  24. Olsen NK, Press JM, Young JL. Bursal injections. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:36-43.

  25. Injection and corticosteroids. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:37-9.

  26. Cohen SP, Strassels SA, Foster L, et al. Comparison of fluoroscopically guided and blind corticosteroid injections for greater trochanteric pain syndrome: multicentre randomised controlled trial. BMJ. Apr 14 2009;338:b1088. [Medline]. [Full Text].

  27. Brinks A, van Rijn RM, Willemsen SP, Bohnen AM, Verhaar JA, Koes BW, et al. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med. May-Jun 2011;9(3):226-34. [Medline]. [Full Text].

  28. Shbeeb MI, O'Duffy JD, Michet CJ, et al. Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol. Dec 1996;23(12):2104-6. [Medline].

  29. Cohen SP, Narvaez JC, Lebovits AH, et al. Corticosteroid injections for trochanteric bursitis: is fluoroscopy necessary? A pilot study. Br J Anaesth. Jan 2005;94(1):100-6. [Medline]. [Full Text].

  30. Hofmeister E, Engelhardt S. Necrotizing fasciitis as complication of injection into greater trochanteric bursa. Am J Orthop. May 2001;30(5):426-7. [Medline].

  31. Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg. May 2009;108(5):1662-70. [Medline].

 
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Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
This photo demonstrates one method of stretching the iliotibial band (ITB) in the standing position. One foot is crossed over the other, and the patient leans away from the side being stretched. The exercise is performed by letting the side to be stretched lean in toward the wall. The patient should feel the stretch at the lateral aspect of the hip that is closest to the wall. Stretching should be done in a controlled, sustained manner, never in a ballistic manner with sudden, jerking movements.
This photo demonstrates one method of stretching the iliotibial band (ITB) in the supine position. The foot that is ipsilateral to the stretch is crossed over the contralateral knee. Next, the thigh that is ipsilateral to the stretch is pulled across the midline (adduction). The patient should feel the stretch at the lateral aspect of the hip, in the area shown by the dark line. Stretching should be done in a controlled, sustained manner, never in a ballistic manner with sudden, jerking movements.
 
 
 
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