From the Guidelines
Greater trochanter bursitis treatment should initially focus on conservative measures, including rest, ice application, and activity modification, followed by the consideration of a corticosteroid injection into the bursa for persistent cases, as supported by recent evidence 1. The treatment approach for greater trochanter bursitis aims to reduce inflammation and alleviate pain. Key components include:
- Rest, ice application, and activity modification to reduce inflammation
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management and inflammation reduction
- Physical therapy focusing on hip abductor strengthening, iliotibial band stretching, and core stabilization exercises
- For persistent cases, a corticosteroid injection into the bursa may be considered, with lidocaine alone or in combination with a corticosteroid being viable options 1
- Weight loss for overweight patients and proper footwear to reduce pressure on the bursa
- Avoiding activities that aggravate symptoms
The use of ultrasound (US) can be beneficial in detecting trochanteric bursitis and differentiating it from other conditions such as gluteus medius tendinosis, although differentiation between bursitis and gluteus medius tendinosis may be difficult, and the two may coexist 1. Corticosteroid injections, such as 40mg methylprednisolone or equivalent with local anesthetic, can provide relief for several months in persistent cases 1. Surgery is rarely needed but may be considered for refractory cases that don't respond to 6-12 months of conservative treatment. The effectiveness of these treatments stems from addressing the underlying inflammation and mechanical factors that contribute to bursal irritation at the greater trochanter.
From the FDA Drug Label
For relief of the signs and symptoms of tendonitis For relief of the signs and symptoms of bursitis 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 treatment for Greater Trochanter Bursitis may include 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.
- Thereafter, the total daily dose should not exceed 1000 mg of naproxen. 2
From the Research
Treatment Options for Greater Trochanter 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, such as 24 mg betamethasone and 1% lidocaine, can be effective for patients whose symptoms persist despite conservative therapy 3
- Low-energy shock-wave therapy (SWT) has been found to be superior to other nonoperative modalities in some studies 4
Surgical Options
- Surgical procedures, such as iliotibial band release, subgluteal bursectomy, and trochanteric reduction osteotomy, may be necessary in rare cases of intractable symptoms 3
- Endoscopic treatment options, including bursectomy and fascia lata lengthening, are available for patients with type I and II greater trochanteric pain syndrome who have failed conservative management 5
- Open surgical options, such as longitudinal release of the iliotibial band and proximal or distal Z-plasty, may also be effective for patients with persistent symptoms 4
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 4
- Surgical techniques have been found to be effective in refractory cases, with varying degrees of efficacy depending on the clinical outcome measure 4
- Patient satisfaction and outcomes can vary depending on the treatment modality and individual patient factors 6, 7, 5