From the Guidelines
The initial treatment for greater trochanteric bursitis should include rest, ice application, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for 1-2 weeks, as well as consideration for injection with lidocaine alone or in combination with a corticosteroid if pain persists 1.
Initial Treatment Measures
The treatment aims to reduce inflammation and alleviate pain. Key components include:
- Rest and avoidance of activities that aggravate the pain
- Ice application to the affected area for 15-20 minutes every 3-4 hours during the first few days
- NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily with food) for 1-2 weeks
- Physical therapy focusing on gentle stretching and strengthening exercises for the hip abductor muscles once acute pain subsides
- A home exercise program including side-lying leg raises and iliotibial band stretches performed 1-2 times daily
- Weight loss for overweight patients to reduce pressure on the affected bursa
Diagnostic Considerations
While the primary approach is conservative management, diagnostic imaging such as ultrasound (US) can be useful in detecting trochanteric bursitis and differentiating it from other conditions like gluteus medius tendinosis 1. However, the initial treatment should focus on symptom management rather than immediate diagnostic confirmation.
Injection Therapy
For cases where initial conservative measures do not provide sufficient relief, injection of the bursa with lidocaine alone or in combination with a corticosteroid may be considered 1. This approach can help in reducing inflammation and pain directly at the site of the bursitis.
Outcome and Follow-Up
Most patients experience significant improvement within 2-3 weeks of consistent conservative treatment. Follow-up appointments can help in assessing the response to treatment and adjusting the management plan as necessary.
From the FDA Drug Label
Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. Naproxen may also be used The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
The initial treatment for greater trochanter bursitis may include naproxen. The recommended starting dose is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. The initial total daily dose should not exceed 1250 mg of naproxen. Key points to consider:
- Naproxen sodium is recommended for acute painful conditions when prompt onset of pain relief is desired.
- Dosage adjustment may be necessary based on patient response and adverse events.
- Caution is advised in patients with renal or hepatic impairment, or in elderly patients 2.
From the Research
Initial Treatment for Greater Trochanter Bursitis
The initial treatment for greater trochanter bursitis typically involves conservative measures, including:
- Rest
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Stretching exercises focused on the lower back and sacroiliac joints 3
- Physical therapy measures and analgesics 4
- A local corticosteroid injection may be considered if symptoms persist despite conservative therapy 3, 5
Treatment Options
Treatment options for greater trochanter bursitis may include:
- Conservative therapy, such as NSAIDs and physiotherapy, which can be successful in most patients 5
- Corticosteroid injection, which can be effective in resolving symptoms 3, 6
- Low-energy shock-wave therapy (SWT), which has been found to be superior to other nonoperative modalities in some studies 6
- Surgical options, such as bursectomy, longitudinal release of the iliotibial band, and repair of gluteus medius tears, which may be considered for refractory cases 6
Non-Invasive Treatment
Non-invasive treatment regimens, including intensive pulsed ultrasound therapy, physiotherapy, and iontophoresis, may be effective in resolving symptoms and radiographic findings, even in cases with extensive calcifications 7