The Role of PT in Treating Chronic Trochanteric Bursitis | Blog

The Role of PT in Treating Chronic Trochanteric Bursitis

  Posted: Mar 13, 2020

  Category: MD Newsletter


Some chronic medical conditions and disorders, like dementia, appear almost exclusively later in life, but many others can strike at any age. When they do, these afflictions leave patients with years or even decades to manage their pain and symptoms — a daunting proposition for them and for their physicians.
 
One such condition is trochanteric bursitis (TB), an often chronic regional pain syndrome characterized by the inflammation of the bursa at the greater trochanter. It’s a common problem estimated to affect as many as 5.6 people out of every 1,000 seen by sports medicine practitioners (1). TB’s symptoms include intermittent, aching pain over the lateral aspect of the hip, which can sometimes extend to the thigh and knee, as well. Numbness and paresthesia-alike symptoms can also occur in the upper thigh, and all of these complaints can be exacerbated by specific hip movements, standing or lying down for long periods, and some exercises. In the worst cases, this pain can even relegate patients to wheelchairs (2).
 
While TB occurs most commonly in adults from 40–60 years of age, it can strike people in any age group, limiting function to the point where treatment is required (2). Historically, physical therapy has been one of the most common treatments physicians have recommended for the treatment of TB; though in the 1950s, glucocorticoid injections started gaining popularity. These injections have proven effective, as have surgical solutions, but their effectiveness decreases over time.
 
One study of 75 TB patients found that while corticosteroid and lidocaine injections were an effective therapy with prolonged benefits, patients reported an improvement in pain that decreased steadily from the first, to the sixth, and finally to the 26th week after treatment (2). This suggests that other treatments would be necessary to manage chronic TB pain extended over decades.
 
Another study reported, “One or two local corticosteroid injections gave excellent response in two-thirds [of the 36 patients evaluated], improvement in the remaining cases,” but added, “One-fourth relapsed in two years” (3).
 
Corticosteroid injections can also be prohibitively expensive for some patients. Costs vary depending on provider and insurance coverage but appear to range from as little as a $10 copay to as much as $200 each in addition to the cost of the office visit. The potential side effects of these shots, which the Mayo Clinic reports increase with larger doses and repeated use, are also worrying and can include cartilage damage, bone death, joint infection, nerve damage, tendon weakening or rupture, and tissue changes around the injection site.
 
While corticosteroid injections and surgical interventions can be the best solutions for patients with stubborn symptoms, a systematic treatment review found that traditional nonoperative treatments (e.g. physical therapy, stretching, rest, and anti-inflammatory medications) helped most patients (1).
 
These “conservative” treatments alone can help patients with mild cases of bursitis manage their pain and assist in sustaining the results of surgery and injections over years or decades when continued interventions might not be sustainable.
 
If you’ve recently seen a patient suffering from TB, particularly a young patient, consider contacting our office about the role physical therapy can play in their recovery and in increasing their mobility over time. Together, we may be able to improve their quality of life and keep it elevated for decades to come.
 
Sources:
1. Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. 2011;21(5):447–453. doi:10.1097/JSM.0b013e318221299c 
2. Shbeeb, MI, & Matteson, EL. Trochanteric Bursitis (Greater Trochanter Pain Syndrome). Mayo Clinic Proceedings. 1996;71(6), 565–569. doi:10.4065/71.6.565
3. K.-J. Ege Rasmusse, Fanø N. Trochanteric Bursitis: Treatment by Corticosteroid Injection, Scandinavian Journal of Rheumatology. 1985;14:4, 417-420, DOI: 10.3109/03009748509102047