A bursa is a closed fluid-filled sac near a joint that functions as a gliding surface to reduce friction between the tissues of the body. There are two bursae of the hip. One of them is the trochanteric bursa which is situated just superficial to the greater trochanter. The Greater trochanter is the outside or lateral point of the hip. When this bursa is inflamed, we term it as trochanteric bursitis. It’s also sometimes refered to as ‘hip bursitis’. Pain associated with trochanteric bursitis sometimes occurs after prolonged sitting on hard surfaces, therefore this condition is often called as “weaver’s bottom” or “tailor’s bottom”.
Trochanteric bursitis is a common condition amongst those who lead a sedentary lifestyle as well as those who are physically active. Both hips can be effected, but most frequently it is a unilateral condition. This condition can occur in adults of any age, but most common in women as compared to men (the ratio being 4:1).
It sometimes occurs as a complication of arthroscopic surgery of the hip, but its occurrence is rare.
There are many reasons for developing this condition. It may arise if you accidentally fall on your hip, or if you sleep or lie down only on one side of your body for longer periods of time.
If you play certain sports, carry out physical activities that cause injury to the joint areas, or if the joint area is overused, it may put unwanted strain on the bursa. Such activities may include running up stairs, climbing a mountain, walking for long periods of time, or standing continuously for long periods of time.
It may also occur if your posture is incorrect.
Other conditions of the bone and joints such as rheumatoid arthritis, gouty arthritis, psoriasis, and thyroid disease are also known to cause trochanteric bursitis.
It may also occur as a result of an unusual drug reaction.
Rarely, bursitis can result from an infection.
If there is a history of past surgery around the hip, or if there is a prosthesis in the hip joint, this too can cause trochanteric bursitis to develop.
There may be calcium deposits in the tendons that attach themselves to the trochanter. This can occur due to a condition called gout. When calcium deposits develop, trochanteric bursitis can form.
There are many causes, however, there may be no known cause making it difficult for the physician to diagnose this condition.
Trochanteric bursitis is associated with stiffness and pain around the hip joint. There may also be pain in the thigh region and the buttocks.
There may be pain when a person lies down on the affected side making sleep difficult.
Even as you gently press on the outside of hip, you may feel pain.
Pain can be worse after an activity like climbing stairs.
Diagnosis is based on the history of the outer hip pain. Pain may radiate down the thigh, but it should not radiate down to the foot.
Pain due to trochanteric bursitis is usually confirmed by relief with local injection of an anaesthetic.
Patients complain of pain when climbing up the stairs or when lying on the affected side at night, these are indicative of trochanteric bursitis pain.
Physician may palpate the entire hip and check for tenderness. The tender area is the point of the inflamed bursa. Therefore, history and physical examination is generally enough to make a diagnosis of trochanteric bursitis, but he may order an x-ray to rule out other conditions of the bone and joints such as arthritis, fractures, or even cancer.
MRI, though expensive and not used routinely, gives an accurate image of the bursa.
The goal of treatment is to reduce pain and swelling and to make the hip function normally.
Most importantly, rest should be given to the hip by avoiding certain activities like walking for long periods of time and climbing stairs. Another important step in treatment is to identify the activities that cause the your symptoms, then limit these activities in your daily life.
Every two to three hours ice application can be placed on the affected area for about fifteen to twenty minutes.
Anti-inflammatory medications should be taken to reduce inflammation.
A goal-directed physical therapy program should be employed which proves to be beneficial in many cases.
Your physician may also give a steroid injection to reduce pain and inflammation.
Patients sometimes benefit from losing weight and also from wearing proper foot wear. Being overweight puts enormous pressure on the hips.
Generally there is no infection in a case of trochanteric bursitis.
Surgery is advocated if all other options fail. Surgical drainage and removal of the bursa are sometimes undertaken. If there is any calcified tissue in the bursa due to underlying condition such as gout, then the calcifications can be removed.
PRP for Trochanteric Bursitis
Trochanteric bursitis is a condition characterized by an inflamed, trochanteric bursa. People that suffer from this condition experience lateral hip pain that may extend all the way down to the knee. Trochanteric bursitis is generally caused by repetitive movements, prolonged pressure, or a blow to the hip, for instance a person may develop the condition after a hard fall. An individual afflicted with trochanteric bursitis may find it difficult to participate in many activities they were once able to.
The treatment of trochanteric bursitis typically includes rest, ice, stretching and soft tissue massage. An option for individuals not adverse to alternative treatments is PRP (Platelet Rich Plasma) therapy. Considered by many to be a breakthrough therapy for soft tissue injuries, PRP utilizes the body’s own platelets to heal itself.
PRP may be able to significantly accelerate the rate in which a person with trochanteric bursitis sees their condition improve. In studies, PRP has proven to outperform traditional treatment protocols. It was responsible, at least in part, for helping NFL superstars, Hines Ward and Troy Polamalu, return from their respective injuries in record time, allowing them to participate in the 2009 Super Bowl.
When a person undergoes PRP therapy, platelets are extracted from their own blood and then injected into the site of the injury. Platelets contain growth factors, protein molecules that promote healing. PRP therapy utilizes concentrated amounts of platelets and thus growth factors, to accelerate the healing process.
A doctor might recommend PRP therapy for the teatment of trochanteric bursitis when a patient wants to expedite the healing process. Athletes will often request it so that they can return to competition more quickly than traditional therapies would allow. In studies, PRP has been proven to significantly accelerate the rate in which a person is healed from soft tissue and bone injuries. People that need or want to quickly resume physical activity at full strength, are often good candidates for PRP therapy. The same is true for individuals whose trochanteric bursitis has not responded well to rest, ice, stretching and massage.
PRP is not an inexpensive procedure. An injection can run anywhere between $500 and $1500. Because it is considered by insurance companies to be semi-experimental, it is not covered by most insurance companies. Consequently, individuals that want to undergo PRP therapy will have to pay for it themselves. Another option, offered by some physician’s offices, is installment payments.
PRP Injection Protocol and Procedures
FAQ- Questions to Ask Your Doctor
1. Why is platelet rich plasma therapy considered to be a semi-experimental procedure? Am I putting myself at risk?
2. Is platelet rich plasma therapy safe? Why or why not?
3. What type of side effects can I expect after undergoing platelet rich plasma therapy?
4. Will I experience immediate results after platelet rich plasma therapy? If not, how long will it take?
5. How many injections of platelet rich plasma will I need? What happens if it doesn’t work?
The prognosis is generally good, patients respond well to treatment and return to normal physical activity after a few months of treatment. Most patients respond well to a combination of steroid injections and physical therapy. Steroid injections are often required to be repeated, but some studies have shown patients developing chronic pain at the site of injection with steroid treatment.
If it is caused by an underlying disease like arthritis or gout, then it is more difficult to treat and requires many lifestyle adjustments.
Avoiding overuse of joints in sports is extremely important. Appropriate warm up exercises needs to be done before any physical activity. If overweight, attempts should be made to reduce weight.
Pain can become chronic and constant with limited mobility of the affected limb.
Questions your doctor can ask you at your first doctor visit
- how long have you had pain and when did it first occur?
- Do you have a habit of sleeping on one side?
- Do you have any other illness and are you on any medications
- What is you occupation?
- What sports do you practice?