Bursitis trochanterica – Bursitis of the hip

General information

Bursitis trochanterica is an inflammation of the bursae of the hip joint. There are three larger bursae in the hip joint, which can become inflamed not only by incorrect loading. In the three types of bursitis of the hip joint, parts of the three gluteal muscles that attach to the thigh bone are affected.

These are the muscle gluteus maximus, the muscle gluteus medius and the muscle gluteus minimus. The bursae serve to separate the bone and the muscle from each other and form a sliding layer. They also dampen our movements. The so-called trochanter of the thigh bone is a part of the bone to which many muscles of the hip joint are attached. Bursitis trochanterica is therefore an inflammation of the bursae located between the three gluteal muscles and the upper part of the thigh.

Frequency

It is not possible to say exactly how often an inflammation of the bursa of the hip joint occurs, as many forms of these diseases fortunately heal very well. According to some studies, unilateral bursitis trochanterica is more common in both women and men than bilateral bursitis. Overall, more than half of the patients with bursitis are female.

On average, the disease occurs in 1-2:1000 patients. In order to understand the causes of the development of bursitis trochanterica, the anatomy of the affected structures must first be clarified. The trochanteric mound, a bony structure of the thigh, is a starting point for many muscles of the hip.

This causes enormous mechanical stress in this area, which in turn is largely diverted to the bursa trochanterica. In the case of bursitis trochanterica, the mechanical strain on the bursa has become so great that it has become inflamed. A distinction is made between septic inflammation and aseptic inflammation.

Septic inflammation is a disease caused by external pathogens such as bacteria. Inflammations caused by the bacterium Staphylococcus aureus are particularly common. Aseptic bursitis is an inflammation of the bursa that is caused by the above-mentioned chronic strain.

Especially sports that put a lot of strain on these muscles are therefore risk factors for the development of bursitis trochanterica. Long-distance runners and wrestlers are often affected by the disease, as these sports place enormous strain on the hip muscles. However, people who do not participate in competitive sports, but rather have an incorrect load, can also be affected by bursitis trochanterica.

As a result, the bursae become particularly irritated and an inflammation of the bursae occurs. However, bursitis can also be triggered by a trauma, for example in an accident. In the context of chronic diseases such as rheumatoid arthritis, inflammation of the bursae can also occur.

Other risk factors for the development of bursitis can be pelvic obliquity due to legs of different lengths, poor gait, standing for too long, unaccustomed strain or previous injuries or operations on the hip. Bursitis trochanterica also frequently occurs in people with a bowlegged position. In this case, the angle between the head of the femur and the femoral shaft is relatively small (<120°) compared to non-affected persons.

In addition to the knee joint, the hip joint including the bursa sacs is also affected by a knock-knee position, which can often become inflamed as a result of heavy strain on the affected person. Bursitis trochanterica occurs on both sides with the same probability, often even on both sides. If the symptoms occur repeatedly on one side of the body, it may be helpful to observe one’s own gait or still image more closely.

As already mentioned, the bursitis of the hip region is often due to sustained pressure on the hip joint. This is often caused by incorrect posture, differences in leg length, pelvic obliquity or a relieving posture that is adopted in the context of chronic back pain. Leg malpositions resulting from operations or injuries to the lower extremity can also lead to uneven loading of the hip joint.

If bursitis trochanterica causes difficulties on one side of the body, it may be helpful to relieve the strain on that side by taking appropriate measures, such as the use of walking aids. Walking training together with a physiotherapist can also help to compensate for incorrect strain. If bursitis trochanterica occurs on both sides of the body, the patient is often considerably restricted due to pain.

In the aseptic form of bursitis trochanterica of the hip joint, there is initially an increased feeling of pressure and friction in the joint. The pain increases slowly at first. If the load is not stopped, the pain increases more and more until the typical signs of inflammation appear.

Since there is often also an accompanying tendon inflammation on the thigh, there may also be stabbing pain while running, since the tendons of the thighs run near the bursa. In addition to the pain, the typical signs of inflammation are overheating, redness and swelling of the affected joint. The four different signs of inflammation can occur to varying degrees.

In most cases, the pain occurs before the other three symptoms or is perceived by the patient first. It is important to pay attention to the pain when it occurs instead of ignoring it and to start by sparing the joint. The septic form of bursitis, in connection with an infection, is usually preceded by minor injuries.

Many patients therefore report a trauma. The typical signs of inflammation also occur in this form. Sometimes the septic form also causes fever and chills.