What is it?
Trochanteric bursitis is something that’s usually missed by a doctor who doesn’t examine the patient. It can be misunderstood to be a herniated disc, sciatica, or a painful hip. There’s many different causes. One of the salient features is it’s four times more prevalent in females than males because their hips are broader. With inadequate exercises and tight muscles and sitting around, the iliotibial band, which goes to the lateral aspect of the tibia below the knee, the outside part, goes up and attaches to the iliac crest. There is a short muscle called the iliacus muscle. And then it turns into a wide flat tendon over the trocanter of the hip, which is the bony part of your hip on the outside.
If this tightens up sufficiently, it causes inflammation as it pops back and forth. And it’s very much similar to a rubber band over the edge of a Formica desk. And the pressure is exquisite at that area, and your body forms inflammation of a bursa there. The bursa prevents it from tearing or damaging. If you can reduce the inflammation of the bursa with an injection or an anti-inflammatory medication, and you can stretch out the iliotibial band with appropriate physical therapy, the problem goes away. Rarely, if ever, is surgery necessary for this. Unfortunately, if one does not take the clothes off the patient and actually examine them, one doesn’t know whether it exists.
One of the interesting things with the history is that you can not lay on the painful side because it hurts. Lying on the other side is not painful. The other thing that can aggravate it that the therapist should be aware of, is when riding a bicycle, it can get worse because it makes the iliacus muscle and the tensor fasciae latae, which is a wide, flat tendon can pop back and forth, irritating the bursa. It becomes very debilitating.
I’ve injected these in my office many times. I start off with an anti-inflammatory medication, specifically Naproxen twice a day, and physical therapy. And if in three weeks it doesn’t work, I will go and recommend an injection. The injection relieves the pain almost immediately. The injection consists of four or five cc’s of 1% lidocaine, and 1 cc of 40 or 80 milligrams per cc of dexamethasone, or Depo-Medrol. This usually relieves the problem. But without physical therapy, the injection will be short-lived, and in three to six months, it will come back. So you have to relieve the pressure on the corner of the “formica desk”, or in this case the hip, to prevent it from reoccurring.
