From the Guidelines
The recommended treatment for greater trochanteric bursitis with associated tendinopathies typically begins with conservative measures, including rest, activity modification, and physical therapy focusing on hip abductor strengthening exercises and stretching of the iliotibial band. Initial management may also include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for 1-2 weeks to help reduce pain and inflammation, as well as ice application for 15-20 minutes several times daily for symptomatic relief 1.
Key Components of Treatment
- Physical therapy should be continued for 4-6 weeks, emphasizing eccentric strengthening of the gluteal muscles
- For persistent symptoms, corticosteroid injections into the bursa can provide significant relief, though effects may be temporary
- Ultrasound guidance improves injection accuracy
- Extracorporeal shock wave therapy (ESWT) may be beneficial for recalcitrant cases, as it uses acoustic shock waves to impart structural and neurochemical alterations that may reduce pain and promote tendon healing 1
- Weight loss is recommended for overweight patients as excess weight increases pressure on the affected area
Additional Considerations
- Surgical intervention, such as bursectomy or iliotibial band release, is rarely needed and reserved for cases that fail to respond to 6-12 months of conservative treatment
- Technique modification for athletes and manual laborers aims to minimize the repetitive stresses placed on tendons to eliminate pain and promote healing 1
- Other modalities such as ultrasonography, iontophoresis, and phonophoresis may also be considered, although evidence for their consistent benefit in tendinopathies is weak 1
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 total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen.
The recommended treatment for greater trochanteric bursitis with associated tendinopathies is 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, and thereafter, the total daily dose should not exceed 1000 mg of naproxen 2.
- Key considerations:
- Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
- Naproxen may be used for the relief of the signs and symptoms of tendonitis and bursitis 2.
From the Research
Treatment Options for Greater Trochanteric Bursitis
- Conservative measures are often the first line of treatment, including rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching exercises focused on the lower back and sacroiliac joints 3
- Corticosteroid injections into the inflamed bursa may be beneficial for patients whose symptoms persist despite conservative therapy 3, 4
- Ultrasound-guided injections into the greater trochanteric bursa may be more effective than injections into the subgluteus medius bursa for treatment of greater trochanteric pain syndrome 4
- Surgical options, such as iliotibial band release, subgluteal bursectomy, and trochanteric reduction osteotomy, may be considered in rare cases of intractable symptoms 3, 5
Factors Associated with Treatment Outcome
- Patients with knee osteoarthritis and lumbar facet joint or sacroiliac joint pain may experience less therapeutic effect from ultrasound-guided trochanteric bursa injections 6
- Age, gender, body mass index, and pain duration are not independent predictors of a clinically successful outcome 6
- Ultrasound findings of tendinosis, bursitis, partial or full-thickness tear, and enthesopathic changes are not significantly associated with treatment outcome 6