Trochanteric Bursitis
Trochanteric Bursitis picture album Several pictures illustrating the anatomy, evaluation, and treatment of trochanteric bursitis.
The greater trochanter is a bony prominence on the femur (the thigh bone).  It can be felt on  the side of the hip. Several muscles attach to or pass over the femur.  Movement creates friction as the muscles  and tendons rub against the bone.  A bursa is a thin sack of fluid that lies between the bone  and the soft tissue structures that helps to limit friction and prevent inflammation.  The  trochanteric bursa lies between the greater trochanter of the femur (the point of the hip) and a  long tendon known as the iliotibial band. Trochanteric bursitis is when the bursae, muscles, and tendons around the greater trochanter  become inflamed.  Inflammation may occur with a traumatic blow to the hip.  It may also occur  as the muscles and tendons rub back and forth against the bone and bursae.  Running,  especially on uneven ground, a leg length discrepancy (one leg is slightly shorter than the  other), and anatomical differences can predispose people to developing trochanteric bursitis. Trochanteric bursitis is diagnosed based on a history and physical exam.  Patients may report  a history of a blow to the hip, perhaps as the result of a fall or while playing contact sports.   Runners are also predisposed, especially if they run on a slanted surface.  People who have  had hip surgery can develop hip bursitis as well. During the physical exam, the hip is tender over the greater trochanter.  People with a leg  length discrepancy are more likely to develop trochanteric bursitis. X-rays may be obtained to look for other causes of hip pain such as a fracture of the greater  trochanter. Trochanteric bursitis is almost always treated without surgery.  Treatment includes non- steroidal anti- inflammatory drugs (NSAIDs) such as ibuprofen, correction of any leg length  discrepancy, stretching exercises, ice, and activity modification.  Steroid injections (cortisone  shots) into the trochanteric bursae can provide relief.  Physical therapy may also be beneficial. Physical therapy involves stretching the iliotibial band and other muscles and tendons  surrounding the hip.  Other modalities such as phonophoresis (ultrasound and application of  steroid cream) may be utilized by the physical therapist as well. If non-surgical treatment is not effective, surgical release of the iliotibial band and removal of  the bursae has been successful in relieving symptoms.