What is the management for mild thickening of the Gruber's (Greater Trochanteric) bursa?

Management of Mild Thickening of Gruber's (Greater Trochanteric) Bursa

The management of mild thickening of Gruber's (Greater Trochanteric) bursa should begin with conservative measures, including rest, NSAIDs, and stretching exercises, followed by corticosteroid injection into the greater trochanteric bursa if symptoms persist. 1

Initial Conservative Management

• Activity modification: Reduce activities that aggravate the pain and avoid pressure on the affected area 2
• NSAIDs: Administer for pain relief and to reduce inflammation 1, 3
• Stretching exercises: Focus on exercises for the lower back and sacroiliac joints 1
• Orthoses or accommodative padding: May help reduce pressure on the affected area 2
• Open-backed shoes: Can reduce pressure on the area if footwear is contributing to symptoms 2
• Weight loss: If indicated, to reduce pressure on the affected joint 2
• Physical therapy: To strengthen surrounding muscles and improve biomechanics 3, 4

Second-Line Treatment

If symptoms persist after 6-8 weeks of conservative management:

• Corticosteroid injection: Ultrasound-guided injection into the greater trochanteric bursa (rather than the subgluteus medius bursa) has shown significantly better pain reduction 5
  • A solution containing corticosteroid (such as betamethasone 24 mg) and local anesthetic (1% lidocaine) is recommended 1
  • Ultrasound guidance improves accuracy of injection placement 2

Diagnostic Imaging

• Ultrasound: Can detect trochanteric bursitis, showing bursal thickening and fluid collections 2
  • Helps differentiate bursitis from gluteus medius tendinopathy, though these conditions may coexist 2
• MRI: Useful for assessing peritrochanteric structures including the gluteus minimus and medius muscles, abductor tendons, and trochanteric bursa 2
  • No additional benefit has been documented for contrast-enhanced MRI versus non-contrast MRI 2

Treatment for Refractory Cases

For patients with persistent symptoms despite conservative management and injections:

• Immobilization: In particularly acute or refractory cases, immobilization may be considered 2
• Surgical intervention: For truly recalcitrant cases that fail all conservative measures 3
  • Options include endoscopic trochanteric bursectomy 6
  • Iliotibial band release may be performed in conjunction with bursectomy 6
  • In rare cases, trochanteric reduction osteotomy may be considered 2

Important Clinical Considerations

• Differentiate trochanteric bursitis from other causes of lateral hip pain, including hip osteoarthritis, lumbar pathology, and gluteal tendinopathy 4
• Recent evidence suggests many cases of "trochanteric bursitis" may actually represent pathology of the gluteus medius or minimus muscles rather than true bursitis 4
• When performing corticosteroid injections, ensure proper placement into the greater trochanteric bursa rather than the subgluteus medius bursa for optimal results 5
• For diagnostic injections, lidocaine alone can be used to confirm the bursa as the pain source before proceeding with corticosteroid injection 2