Trochanteric Bursitis
Overview
Trochanteric bursitis, also known as hip bursitis, is a common problem causing pain in the hip and along the outer upper thigh. Bursitis refers to inflammation of a bursa (fluid-filled sacs that cushion joints), and trochanter refers to the top end of the femur (thigh bone). Most common in runners, the condition can affect cyclists, soccer players and football players as well. It can also result from a direct blow or fall onto the side of the hip. In addition, patients who’ve had a hip replacement or surgery for a hip fracture sometimes develop the problem.
Our approach to trochanteric bursitis
The orthopedic medicine team at UCSF includes primary care sports medicine doctors; orthopedic surgeons who specialize in sports injuries, including hip conditions; athletic trainers; and physical therapists. These experts work together to relieve pain and restore mobility, so that patients can return to their normal lives and favorite activities.
Most people with trochanteric bursitis recover with simple measures, such as rest, applying ice to the area, specific stretching exercises and use of oral anti-inflammatory medications. If these first-line treatments fail, certain injections may provide relief. For persistent cases, surgery is an option.
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Signs & symptoms
People with trochanteric bursitis may experience the following:
- pain or a burning sensation in the hip or outer edge of the upper thigh, with the feeling sometimes traveling toward the knee but rarely crossing the knee
- Tenderness over the outer hip bone area
- Pain when lying and sleeping on the affected side
Early on, people may experience this pain only after engaging in a sport or other physical activity, but eventually it may be triggered simply by walking upstairs or uphill, or by walking long distances.
Diagnosis
During the physical exam, a doctor checks for tenderness in the outer hip area as well as tightness of the iliotibial band (IT band), a thick tendon that runs from the hip down the outer thigh, attaching just below the knee. X-rays may be ordered if the doctor suspects that bony spurs (small growths of bone) or calcium deposits may be adding to the problem. A diagnostic ultrasound or an MRI may be ordered if the diagnosis isn't clear or if the patient doesn't improve with treatment.
Treatments
The initial treatment of trochanteric bursitis includes rest, anti-inflammatory medications, ice and stretching.
- Rest. This is the most important part of treatment. At least initially, patients need to avoid any activity that may worsen symptoms. Prolonging inflammation in the area will only lengthen the recovery period. However, some types of exercise, such as swimming and walking on flat surfaces, may be OK, so long as they don't make the condition worse.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Certain over-the-counter medications, such as ibuprofen or naproxen, can decrease the inflammation and pain.
- Ice. Applying ice packs to the area can lessen symptoms by bringing down the inflammation. Initially, this can be done every three to four hours, and is especially helpful following exercise and physical therapy. A thin cloth or paper towels should be placed between the ice pack and skin to avoid damaging skin, and the pack should be applied for no longer than 20 minutes at a time.
- Stretching. Many patients with trochanteric bursitis have a tight IT band. A regular routine of stretching the IT band, along with strengthening exercises for the surrounding hip muscles, usually improves symptoms over the course of just a few weeks. Massaging the IT band with a foam roller is also helpful, though it can be painful at first. Even after the pain is resolved, regular stretching is key to staying symptom free. Doctors may prescribe a structured, supervised physical therapy program to address the condition and keep it from recurring.
If the treatments above fail to bring adequate relief, there are other options to consider:
- Injections. Cortisone is a steroidal hormone that can relieve pain by reducing inflammation. It can be injected directly into the bursa in patients who continue to have pain despite adhering to their treatment regimen. It's usually given with lidocaine, an anesthetic that brings immediate pain relief, and ultrasound imaging may be used to guide placement of the injection. In some cases, the doctor may consider other types of injections, such as trigger point or platelet-rich plasma injections, and a therapeutic technique called dry needling.
- Surgery. In rare cases, when noninvasive treatments haven't led to improvement, surgery to remove the inflamed bursa may be an option. This minimally invasive procedure uses an arthroscope (an endoscope for joints) that can be passed through small incisions. Patients generally go home the same day and can usually walk the following day with only mild discomfort.
Recovery
With proper care, most people begin to feel better quickly, with symptoms resolving in six to 10 weeks. Physical activities should be resumed gradually, so the problem doesn't recur.
Frequently Asked Questions
- When can I shower after surgery?
You'll need to keep the incisions clean and dry until your first post-op visit, about a week after surgery. At that time, you'll likely be cleared to shower, but don't submerge the surgical site in a bathtub or swimming pool until three to four weeks have passed since your surgery.
- When should I start physical therapy?
You can start after your first post-op appointment, approximately one week after surgery.
- How long will I be on crutches?
Most patients need crutches only to help with balance and can stop using them within the first week.
- When can I drive after hip bursitis surgery?
Patients can drive once they no longer need to use crutches, typically within the first week after surgery.
- When can I return to school or work?
Most patients are ready to return to school or desk work five to seven days after surgery. If you’re able to work from home, your initial recovery period may be easier. If you have a physically demanding job that requires prolonged standing, walking or lifting, you may need more than a month for a safe recovery and medical clearance before returning to work.
- When can I return to recreational activities?
Generally, people are able to resume playing sports and pursuing other physical activities about six to eight weeks after arthroscopic surgery for trochanteric bursitis.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
