Physical Medicine and Rehabilitation for Trochanteric Bursitis Medication

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

Medication Summary

For this musculoskeletal condition, medications are used primarily to decrease pain and inflammation. The most commonly used medications are oral NSAIDs and focal corticosteroid injections; these are employed in conjunction with the rest of the rehabilitation plan.

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Nonsteroidal anti-inflammatory drugs

Class Summary

Oral NSAIDs can help to decrease pain and inflammation and may be used for several weeks. Various oral NSAIDs can be used. The choice of an NSAID is largely a matter of convenience (how frequently doses must be taken to achieve adequate analgesic and anti-inflammatory effects) and cost.

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Ibuprofen (Motrin, Advil, Nuprin, Rufen)

 

DOC for mild to moderate pain. Ibuprofen inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

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Ketoprofen (Oruvail, Orudis, Actron)

 

For relief of mild to moderate pain and inflammation. Small doses are indicated initially in patients with a small body size, in elderly patients, and in persons with renal or liver disease. Doses >75 mg do not increase the therapeutic effects. Administer high doses with caution and closely observe the patient for response.

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Naproxen (Anaprox, Naprelan, Naprosyn)

 

For relief of mild to moderate pain. Naproxen inhibits inflammatory reactions and pain by decreasing the activity of cyclo-oxygenase, which is responsible for prostaglandin synthesis.

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Flurbiprofen (Ansaid)

 

May inhibit cyclo-oxygenase enzyme, which in turn inhibits prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.

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Corticosteroids

Class Summary

In contrast to the widespread systemic distribution of an oral anti-inflammatory drug, a local corticosteroid injection can achieve focal placement of a potent anti-inflammatory agent at the site of maximal tenderness or inflammation. When corticosteroid injections are used, there are a variety of corticosteroid preparations from which to choose. Commonly, the corticosteroid is mixed with a local anesthetic agent prior to injection. Again, there are various local anesthetic agents from which to choose.

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Methylprednisolone (Depo-Medrol, Solu-Medrol, Medrol, Adlone)

 

Used commonly for local injections of bursae or joints to provide a local anti-inflammatory effect while minimizing some of the GI and other risks of systemic medications.

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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.

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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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