What is the treatment for trochanteric bursitis?

Treatment of Trochanteric Bursitis

The first-line treatment for trochanteric bursitis includes NSAIDs, physical therapy, activity modification, and corticosteroid injections, with surgical options reserved for refractory cases. 1

Diagnosis

• Trochanteric bursitis presents with chronic, intermittent aching pain over the lateral aspect of the hip 2
• Diagnosis is primarily clinical, based on lateral hip pain and characteristic tenderness over the greater trochanter 3
• Radiographs should be obtained first to rule out other causes of hip pain 1
• Ultrasound can effectively detect trochanteric bursitis and differentiate it from other conditions, though it may be difficult to distinguish from gluteus medius tendinosis 1
• MRI can assess peritrochanteric structures including the gluteus minimus and medius muscles, abductor tendons, and the trochanteric bursa 1

Non-Surgical Treatment Algorithm

First-Line Treatment

1. NSAIDs

   • Recommended for pain relief and anti-inflammatory effects 1, 4
   • For acute bursitis, naproxen 500mg initially, followed by 500mg every 12 hours or 250mg every 6-8 hours as needed 4
   • Total daily dose should not exceed 1250mg initially, then 1000mg for maintenance 4

2. Physical Therapy

   • Stretching exercises for the iliotibial band 5
   • Strengthening of hip abductor muscles 5
   • Activity modification to reduce pressure on the affected area 1

3. Supportive Measures

   • Ice application for 10-minute periods through a wet towel for acute pain relief 1
   • Weight loss if indicated 1
   • Accommodative padding 1

4. Corticosteroid Injection

   • Local injection of corticosteroid into the trochanteric bursa 1
   • Ultrasound guidance improves accuracy 1
   • Can provide both diagnostic information and therapeutic benefit 1

Second-Line Treatment (if no improvement after 6-8 weeks)

• Consider alternative diagnoses 1
• Low-energy shock wave therapy (SWT) has been shown to be superior to other non-operative modalities 5
• Intensive pulsed ultrasound therapy 6
• Iontophoresis 6
• Continued physical therapy with more intensive regimen 5

Surgical Treatment (for refractory cases)

Indicated when symptoms persist despite 2-3 months of conservative treatment 5, 7:

1. Endoscopic or open bursectomy - removal of the inflamed bursa 5, 7
2. Iliotibial band release - longitudinal release or Z-plasty 5, 7
3. Repair of gluteus medius tears if present 5

Treatment Efficacy

• Conservative treatment resolves symptoms in 49-100% of cases 5
• Corticosteroid injections provide significant relief in most patients 5, 3
• Surgical intervention has high success rates (>80%) for refractory cases 5

Common Pitfalls and Caveats

• Differentiation between trochanteric bursitis and gluteus medius tendinosis can be difficult, and the two conditions may coexist 1
• Symptoms may be confused with hip osteoarthritis, lumbar spine pathology, or other causes of lateral hip pain 3
• Corticosteroid injections should be ultrasound-guided to ensure proper placement 1
• For patients with hip prostheses, extracapsular disease associated with adverse reactions to metal debris (ARMD) could be misinterpreted as trochanteric bursitis 1
• Complete resolution may require multiple treatment modalities rather than a single approach 5