eMedicine Specialties > Sports Medicine > Hip

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 (Tailbone Pain, Coccydynia) Service, UMDNJ-New Jersey Medical School
Coauthor(s): Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation, Acting Director of Sports Medicine, UMDNJ-New Jersey School of Medicine; Lead Physician, Practice Medical Director of University Hospital PM & R Clinic; 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
Contributor Information and Disclosures

Updated: Sep 28, 2007

Follow-up

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

Complications

  • Complications due to trochanteric bursitis 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.7 (See also the eMedicine article Necrotizing Fasciitis.)
  • 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.

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.

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.3 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.3

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.

Miscellaneous

Medicolegal Pitfalls

  • Never inject corticosteroid into a site that appears infected.
  • In the presence of significant trauma, always check radiographs for fractures before proceeding with treatment.
  • Strongly consider radiographs before any injection of corticosteroids.
  • If there is a clinical suspicion that the pain may be secondary to metastatic cancer, consider performing a bone scan study, even if plain film findings are normal.

Special Concerns

  • Pregnancy: A focal corticosteroid injection can be performed during pregnancy. Avoid the use of oral NSAIDs, especially in the third trimester.
  • Pediatric patient: Obtain written, informed consent from the parent or legal guardian of any patient who is a minor before proceeding with any injection.
  • Geriatric patient: Be cautious when administering oral NSAIDs to elderly patients.
 
Acknowledgments

Greg Gazzillo, 4th year medical student, New Jersey Medical School–UMDNJ, Class of 2007, assisted with the 2006 revision of this manuscript.

Debra Ibrahim, 4th year medical student, New York College of Osteopathic Medicine, Class of 2008, assisted with the 2007 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
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References

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

  2. 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].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

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

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

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

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

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

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

  13. Snider RK. Hip and thigh. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy Orthopedic Surgeons; 1997:264-303.

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

  15. 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; 1999:171-203.

  16. 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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Further Reading

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Keywords

external snapping hip syndrome, lateral snapping hip syndrome, extra-articular snapping hip syndrome, greater trochanteric bursitis, greater trochanteric pain syndrome, GTPS, hip pain, thigh pain

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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 (Tailbone Pain, Coccydynia) Service, UMDNJ-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, Acting Director of Sports Medicine, UMDNJ-New Jersey School of Medicine; Lead Physician, Practice Medical Director of University Hospital PM & R Clinic
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 for 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 for Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Craig C Young, MD, Associate 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, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, 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: Nothing to disclose.

 
 
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