What is the treatment for trochanteric bursitis?

From the Guidelines

Trochanteric bursitis can be effectively treated with a combination of rest, physical therapy, medications, and in some cases, more invasive procedures, with the most recent evidence suggesting that ultrasound-guided injections can be a useful tool for diagnosis and treatment 1. When treating trochantic bursitis, it is essential to prioritize a multimodal approach to manage pain and inflammation, improve function, and prevent recurrence.

• Initially, reduce activities that aggravate the pain and apply ice to the affected area for 15-20 minutes several times daily to reduce inflammation.
• Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) can help manage pain and inflammation for 1-2 weeks.
• Physical therapy focusing on hip strengthening and stretching exercises is crucial for long-term improvement, particularly targeting the iliotibial band and gluteal muscles, as evidenced by the effectiveness of ultrasound in detecting trochanteric bursitis and guiding injections 1.
• Foam rolling the lateral thigh can also help reduce tension.
• For persistent cases, a corticosteroid injection (typically methylprednisolone 40mg with lidocaine) into the bursa may provide relief for several months, as suggested by Robbins et al 1.
• Weight loss is recommended for overweight patients as excess weight increases pressure on the bursa.
• Avoid sleeping on the affected side and consider using a pillow between your legs when sleeping on your side.
• Most cases resolve within a few weeks with conservative treatment, but chronic cases may require ultrasound-guided injections or rarely, surgical intervention to remove the inflamed bursa, with ultrasound being a valid and useful tool for detecting interval changes in lesion size and grade 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 intra-articular or soft tissue administration of triamcinolone acetonide injectable suspension is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis.

Treating Trochantic Bursitis:

• Naproxen may be used for the management of acute painful conditions, including bursitis. The recommended starting dose is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required 2.
• Triamcinolone acetonide injectable suspension can be used as adjunctive therapy for short-term administration in acute and subacute bursitis, including trochantic bursitis 3.

From the Research

Treatment Options for Trochanteric Bursitis

• Conservative measures are the first line of treatment, including rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching exercises focused on the lower back and sacroiliac joints 4
• Corticosteroid injection, such as 24 mg betamethasone and 1% lidocaine, can be effective for patients whose symptoms persist despite conservative therapy 4
• Low-energy shock-wave therapy (SWT) has been found to be superior to other nonoperative modalities in some studies 5

Surgical Interventions

• Surgical procedures, such as iliotibial band release, subgluteal bursectomy, and trochanteric reduction osteotomy, can be considered for patients with intractable symptoms 4
• Other surgical options, including bursectomy, longitudinal release of the iliotibial band, proximal or distal Z-plasty, osteotomy, and repair of gluteus medius tears, have been reported to be effective in refractory cases 5

Efficacy of Treatment

• Symptom resolution and the ability to return to activity have been reported to range from 49% to 100% with corticosteroid injection as the primary treatment modality, with and without multimodal conservative therapy 5
• Surgical techniques have been found to be superior to corticosteroid therapy and physical therapy in some studies, with efficacy varying depending on the clinical outcome measure 5