Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Trochanteric Bursitis

Over the upper lateral part of the femur, beneath the fascia lata, lies a superficial bursa, with a deeper one between the tendon of the gluteus medius muscle and the posterior surface of the greater trochanter. In cases of falls or blows affecting the hip, the superficial bursa can become the site of bleeding, sometimes resulting in clot formation. Clots are gradually transformed into loose bodies or
adhesions which give rise to inflammation and accumulation of fluid.
Inflammation secondary to friction and overuse can affect either bursa, and is a more common cause of pain than hemorrhagic bursitis. An excessive pronation of the foot (and other malalignments) can
contribute to overuse in this region, as can running on cambered roads.

Symptoms and diagnosis

– Pain is particularly pronounced during running.
– Intense pain is caused by swelling and inflammation; this rarely resolves spontaneously, so medical advice should be sought.
– Local tenderness occurs over the upper, lateral part of the thigh.
– Pain can be elicited by passive adduction (of the leg) at 90° of hip flexion.
– Impaired function and limping are caused by pain and discomfort.
– Pain radiates down the thigh at night.
– Loose bodies and adhesions in the bursa can give rise to crepitus (creaking sensations) during hip movements and can sometimes be felt as small, mobile beads when the skin overlying the bursa is palpated.
– To confirm the diagnosis the doctor may ask the athlete to lie down on the healthy side and raise the leg on the tender side. This compresses the bursa, resulting in severe pain. If the same movement is carried out against resistance, the pain increases.

Treatment

The athlete should:
– rest the injured area;
– apply cooling to the area;
– run on even surfaces.

The doctor may:
– prescribe an orthotic device if, for example, excessive foot pronation is present;
– prescribe anti-inflammatory medication;
– aspirate and drain the bursa in cases of bleeding or extensive accumulation of fluid;
– administer a steroid injection;
– in cases of prolonged problems operate to remove loose bodies and any adhesions in the bursa. Usually the bursa itself is also excised.

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