Trochanteric Bursitis

Anatomy

Bursae are small fluid-filled sacs that are usually found around joints or bony prominences. Their purpose is to create lubrication between two [Page 1510]uneven surfaces and provide frictionless movement. In this case, the bursa lies between the femur's greater trochanter, which is the hard bony prominence on the outside of the hip, and a strong tendon known as the iliotibial (IT) band. The IT band runs from the top of the hip, down the side of the leg, to the knee. Its main function is to abduct the leg as if to kick one's leg out to the side. However, when moving the hip forward and backward, as when walking, running, swimming, and biking, the IT band tends to rub over the greater trochanter and may irritate the bursa. When the bursa becomes inflamed, it swells and becomes compressed between the bone and the tendon, thus creating pain.

Causes

Trochanteric bursitis is most often caused by overuse or direct trauma. Direct trauma such as a fall that causes the patient to land on the lateral hip region or a direct blow to the outer hip is more common in women and in the middle-aged or elderly population. However, direct trauma is frequently seen in contact and collision sports as well. These falls or blows will cause bleeding (hematoma) into the bursa, which then results in swelling. Usually, these hematomas are rapidly absorbed by the body, but not infrequently, they may result in scarring, adhesions, and calcifications, leading to a more chronic type of bursitis.

More commonly, chronic repetitive trauma is involved, which can occur from merely running or walking. Conditions that predispose patients to this type of trochanteric bursitis include postural abnormalities, which can be caused by scoliosis, degenerative spinal conditions, a wide pelvis (female runners), hip and knee arthritic conditions, leg length differences, flat feet, high-arched feet, overpronation of the feet, or even oversupination of the feet at heel strike. Improperly fitting shoes, worn-out shoes, running on uneven or hard (cement) surfaces, and sudden increases or changes in training are other causes of trochanteric bursitis. Another cause occurs in cycling when the seat is too high and the cyclist has to rock from side to side when pedaling, which results in repetitive sliding of the IT band over the bursa. At times, the bursitis develops spontaneously without any apparent cause.

Symptoms

Patients affected by trochanteric bursitis will complain of a deep ache or burning pain over the greater trochanter on the outside of the hip. It will usually be worse with activity and may be worse both after rising in the morning or after prolonged sitting. It may get better after the first few steps only to recur later after walking for a ½ hour or more. The pain may radiate down the side of the leg toward the knee or ankle or into the buttock. The pain is usually worse at night while trying to lie on the affected side.

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