What is the trochanteric bursa?
The trochanteric bursa, often referred to as the bursa of the hip, is a membranous sac that lines the greater trochanter (outer bony bump of the hip), allowing the overlying iliotibial band (IT band) to glide back and forth during activities without friction. In the normal, non-pathologic state, there is very little fluid in the bursa and the tissue is collapsed on itself and comprised of little substance.
What is trochanteric bursitis?
Trochanteric bursitis refers to an inflammation of the trochanteric bursa that typically develops over several weeks to months, causing pain and dysfunction. The condition is correlated with low back pain and degenerative disc disorders of the lumbar spine. As the lumbar and pelvic muscles become deconditioned, excessive stress is placed on the hip abductors, which are overloaded and cannot maintain proper pelvic balance during walking or standing. As a result, the loss of pelvic balance places excessive stress on the IT band, which becomes tight and rubs on the greater trochanter. The increased pressure causes inflammation and thickening of the trochanteric bursa (bursitis), ultimately leading to pain and dysfunction.
How is trochanteric bursitis treated?
Treatment for trochanteric bursitis is centered around IT band stretching, hip abductor strengthening, and core/paraspinal muscle strengthening and conditioning. Often, the pain from bursitis prevents patients from being able to participate in physical therapy and a corticosteroid injection into the trochanteric bursa may be performed to give relief. Despite the short-lived nature of the injection, patients who complete a full course of therapy are often significantly improved at the time the injection wears off and occasionally require a second injection to completely resolve the condition.
Patients who fail to improve with physical therapy and injections may be candidates for a minimally invasive procedure to debride the trochanteric bursa and partially release the tight IT band. The procedure, although good at reducing pain, can result in reduced strength in the hip and as a result should be considered cautiously.