From the Guidelines
Treatment for greater trochanteric bursitis should prioritize conservative measures, including rest, activity modification, ice application, and over-the-counter NSAIDs, with corticosteroid injections considered if conservative measures fail, as supported by recent evidence 1. The initial approach to managing greater trochanteric bursitis involves conservative strategies aimed at reducing inflammation and alleviating pain. This includes:
- Rest and activity modification to avoid exacerbating the condition
- Ice application to reduce inflammation
- Over-the-counter NSAIDs, such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), for 1-2 weeks to manage pain and inflammation
- Physical therapy, focusing on stretching exercises for the iliotibial band and strengthening of hip abductor muscles, typically 2-3 sessions per week for 4-6 weeks
- Weight loss for overweight patients to reduce pressure on the affected area
If these conservative measures fail to provide adequate relief, corticosteroid injections (typically methylprednisolone 40mg with lidocaine) into the bursa can be considered, as they can provide significant relief for 3-6 months 1. For persistent cases, extracorporeal shock wave therapy may be an option. Surgery, involving either open or endoscopic bursectomy, is rarely needed but may be considered for refractory cases. The condition often results from friction between the greater trochanter and the overlying iliotibial band, due to biomechanical issues, overuse, or direct trauma. Most patients respond well to conservative treatment within 2-3 weeks, though complete resolution may take several months. Ultrasound (US) can be used to detect trochanteric bursitis and guide injections 1, and it is a valuable tool in the diagnosis and management of this condition.
From the Research
Treatment Options for Greater Trochanteric Bursitis
The treatment options for greater trochanteric bursitis include:
- Conservative measures such as rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching exercises focused on the lower back and sacroiliac joints 2
- Corticosteroid injection into the inflamed bursa, which has been shown to be effective in resolving symptoms 2, 3
- Physical therapy measures, including intensive pulsed ultrasound therapy, physiotherapy, and iontophoresis 4
- Low-energy shock-wave therapy (SWT), which has been found to be superior to other nonoperative modalities in some studies 3
- Surgical procedures such as iliotibial band release, subgluteal bursectomy, and trochanteric reduction osteotomy, which may be necessary in rare cases of intractable symptoms 2, 3
- Subfascial platelet-rich plasma (PRP) injection, which has been shown to be effective in relieving pain and improving function in some patients 5
- Enthesis needling, which has also been found to be effective in relieving pain and improving function in some patients 5
Non-Invasive Treatment Options
Non-invasive treatment options for greater trochanteric bursitis include:
- Conservative measures such as rest, NSAIDs, and stretching exercises 2
- Physical therapy measures, including intensive pulsed ultrasound therapy, physiotherapy, and iontophoresis 4
- Low-energy shock-wave therapy (SWT) 3
- Subfascial platelet-rich plasma (PRP) injection 5
- Enthesis needling 5
Invasive Treatment Options
Invasive treatment options for greater trochanteric bursitis include: