Trochanteric Bursitis Follow-up

  • Author: Patrick M Foye, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Aug 31, 2010
 

Return to Play

The athlete may be expected to return to play without restrictions when the following goals have been achieved:

  • Resolution of symptoms
  • Resolution of any positive physical examination findings (eg, limping, tenderness to palpation)
  • Adequate performance of sports-specific practice drills, without recurrence of symptoms or physical examination findings
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Complications

  • Complications due to trochanteric bursitis (greater trochanteric pain syndrome, GTPS) include progressive or persistent pain, with associated limping and decreased mobility.
  • Potential complications due to focal corticosteroid injection include bleeding, bruising, infection, and allergic reactions. Necrotizing fasciitis from a single steroid injection of the greater trochanteric bursa has been reported.[15]
  • In patients with diabetes, transient elevation of blood glucose levels may occur after a corticosteroid injection.
  • Intravascular injection could potentially cause cardiac arrhythmia due to the local anesthetic.
  • Peripheral nerve dysfunction is possible if the injection is administered very near or within a major nerve.
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Prevention

Prevention may include emphasis on an appropriate training schedule for the patient and avoidance of constant unidirectional activities on banked surfaces. For example, if running must be done on a banked surface, ideally, the athlete should spend half the time running each way on the embankment to avoid always overloading the same tissues on one side of the body. Athletes who participate in contact sports (eg, hockey) should be educated regarding the appropriate use and size of protective padding. Athletes in endurance sports should be educated in the importance of ITB stretching and hip abductor strengthening.

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Prognosis

Most patients respond well to a combination of corticosteroid injection and physical therapy. Some patients may require a repeat corticosteroid injection.

A retrospective study of 164 patients who presented with trochanteric pain found that after 1 year, at least 36% affected patients were still symptomatic, and after 5 years, 29% were still symptomatic; thus, many patients developed chronic pain at this site.[5] Patients with osteoarthritis in the lower limbs had a 4.8-fold risk of persistent symptoms after 1 year, as compared with patients without osteoarthritis.

Patients who were treated with corticosteroid injection were shown to be 2.7 times less likely to have chronic pain at this site at 5 years relative to those treated without such injections.[5]

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Education

As with any medical condition, educate the patient regarding the nature of the condition, the causative factors, and the treatment plan.

As with any injection, educate and instruct the patient to watch for any signs or symptoms of local infection at the injection site.

As with any corticosteroid injection, inform diabetic patients that they may experience a transient increase in blood glucose levels. Patients should also be made aware that symptomatic improvement from the corticosteroid usually does not begin to take effect until a few days after the injection. In fact, they may experience a transient mild increase in symptoms during the time in which the local anesthetic has worn off but when the steroid has not yet begun its therapeutic effect.

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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, 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.

Scott F Nadler, DO  Assistant Director of Occupational/Musculoskeletal Medicine, Assistant Professor of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Director of Sports Medicine, University Hospital

Scott F Nadler, DO is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of Sports Medicine, American Medical Association, Association of Academic Physiatrists, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Russell D White, MD  Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding

References

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

  3. Clarke MT, Arora A, Villar RN. Hip arthroscopy: complications in 1054 cases. Clin Orthop Relat Res. Jan 2003;406:84-8. [Medline].

  4. 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].

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

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

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  9. Fearon AM, Scarvell JM, Cook JL, Smith PN. Does ultrasound correlate with surgical or histologic findings in greater trochanteric pain syndrome? A pilot study. Clin Orthop Relat Res. Jul 2010;468(7):1838-44. [Medline]. [Full Text].

  10. 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].

  11. Vannet N, Ferran N, Thomas A, Ghandour A, O'Doherty A. The use of shockwave therapy in the treatment of of trochanteric bursitis. J Bone Joint Surg Br Proceedings. Jul 2010;92-B:393. [Full Text].

  12. Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med. Oct 2009;37(10):1981-90. [Medline].

  13. Shbeeb MI, O'Duffy JD, Michet CJ Jr, O'Fallon WM, Matteson EL. Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol. Dec 1996;23(12):2104-6. [Medline].

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

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

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

  17. Farmer KW, Jones LC, Brownson KE, Khanuja HS, Hungerford MW. Trochanteric bursitis after total hip arthroplasty: incidence and evaluation of response to treatment. J Arthroplasty. Feb 2010;25(2):208-12. [Medline].

  18. Green SM, ed. Nonsteroidal anti-inflammatories. Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Publishing; 2000:11-2.

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  22. Pretell J, Ortega J, Garcia-Rayo R, Resines C. Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis. Int Orthop. Oct 2009;33(5):1223-7. [Medline].

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  24. Snider RK. Injection and corticosteroids. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy Orthopedic Surgeons; 1997:37-9.

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

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