Diagnostics
For many doctors, a glance diagnosis of the bursitis of the hip joint is sufficient due to the location of the clear signs of inflammation. Of course, the professional experience of the doctor also plays a major role. The pure gaze diagnosis is usually supported by a sonography (colloquially ultrasound) of the hip joint.
Here, the effusion caused by the inflammation is particularly noticeable. In addition, an x-ray can also be carried out, also to rule out bone involvement. However, especially in younger patients, it should be noted that an examination with X-rays also leads to radiation exposure.
For this reason, sonography is generally chosen for children to ensure a reliable diagnosis. Rather rarely a diagnosis of the blood is also carried out. In this case, the parameters typical for an inflammation are also changed.
These include an increase in C-reactive protein (CRP) and an increase in the blood sedimentation rate (BSG). In the septic form of bursitis trochanterica, microbiological detection of the often bacterial pathogen from the point of inflammation is also possible. The diagnosis of bursitis trochanterica is not always easy.
One reason for this is that the exact location of the bursae at the hip joint is not known exactly and varies slightly from patient to patient. If the suspected diagnosis of bursitis trochanterica is made on the basis of the patient’s description and physical examination, an imaging procedure can help to confirm the suspicion. If the cause of chronic hip pain remains unclear despite previous, less complex examinations, such as ultrasound examinations, imaging can be carried out using magnetic resonance imaging (MRI).
This is particularly important for patients with severe pain and a long medical history. This is a form of sectional imaging which, unlike computed tomography (CT), does not require X-rays and is based on the use of a strong electromagnetic field. The MRI examination is suitable for suspected bursa trochanterica because of the better soft tissue imaging compared to conventional x-rays and CT examinations.
It is absolutely harmless for the patient. It should be noted, however, that some implanted pacemakers, prostheses and artificial heart valves are sometimes not suitable for MRI. Information on this is usually provided by the device or prosthesis passport.
Therapy
If bursitis trochanterica has been diagnosed by a doctor, a suitable therapy for the disease should be initiated as soon as possible. There are different options for therapy measures, depending on the individual situation and preference of the person affected. Particularly important for a successful therapy of aseptic bursitis of the hip joint is the protection of the joint, since overloading is a frequent trigger of the inflammation.
Only by adequately sparing the affected structure can the inflammation recede and healing occur. Heat and cold compresses can also be applied to stimulate the blood circulation. In addition, NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or acetylsalicylic acid are used to treat the pain.
These drugs indirectly inhibit the further release of pain mediators. It is particularly important that people who suffer from a tendency to get stomach ulcers should not take these drugs or should take them in very low doses or only in combination with a stomach protector. In particularly severe cases of bursitis, this can also be flushed with glucocorticoids.
In the treatment of septic bursitis of the hip joint, antibiotics are used to combat the bacteria. Here, too, mechanical relief is important to prevent secondary damage. In some cases, the focus of the inflammation is also punctured in order to drain the purulent secretion and thus relieve the joint.
As a rule, bursitis heals relatively quickly. Of course, as with any other inflammation, it can also lead to severe progression, but fortunately this is quite rare. If the bursa continues to be strained despite an existing bursitis trochanterica, there is a risk of chronic inflammation, which can only be healed by surgery under certain circumstances.
A surgical therapy option is necessary if the non-invasive procedures described above could not provide a cure or if it is a so-called peracute inflammation of the bursa. In the case of peracute inflammation, quick action is necessary, as otherwise a so-called sepsis and in the worst case even death of the affected person can occur. Inflammations that occur after an operation also often become chronic, which is why surgical therapy is usually recommended in these cases.
There are two different surgical procedures to treat bursitis trochanterica. On the one hand it is possible to remove the entire inflamed bursa. By removing the inflamed sac, the reason for the present symptomatology is removed, whereby in most cases a complete healing is achieved.
In some cases, however, it is possible that the affected joint is and remains impaired after the operation. This is due to the scars that are inevitably caused by the removal of the bursa. Another surgical procedure is the endoscopic endoscopy of the bursa.
Similar to an arthroscopy, the bursa is opened and treated in a minimally invasive way. This procedure is used particularly in cases of chronic inflammation of the bursa. The advantage is that by leaving the bursa the joint is hardly strained and the joint function is rarely restricted.
In the conservative treatment of bursitis trochanterica, moderate physiotherapeutic exercises can be used in addition to pain medication, heat therapy and anti-inflammatory painkillers. 1. the so-called tractus tibialis stretch is performed in a standing position. The healthy leg represents the supporting leg and is crossed by the diseased leg.
Then, with stretched legs, an attempt should be made to touch the toes. This position is held for 30 seconds and is usually repeated three times. 2. leg lifting should be performed on a gymnastic mat in supine position.
Here the muscles of the straightened out diseased leg are briefly tensed and the leg is then lifted approx. 8-10 cm. This position should be held for a few seconds and repeated three times.
3. hip-extension works similarly. This exercise is performed in prone position. The affected leg is lifted a few centimetres from the mat when stretched.
4. wall squat is a knee bend performed with the back to the wall and supported by a gymnastic ball between the back and the wall. Illustrative examples of all exercises can be found for everyone on the Internet. The extent of the physical activity and the type of exercises used should be discussed in advance with the treating doctor.
Since hip surgery is not the treatment of choice for bursitis trochanterica, it is recommended that the hip be removed from the bursa. Rather, conservative methods such as physical protection, application of heat and the intake of so-called NSAIDs (non-steroidal anti-rheumatic drugs) such as ibuprofen are used. In chronic cases or when the patient is under a high level of suffering, surgery can be considered.
There are two procedures available here. The so-called bursoscopy is the endoscopy of the bursa with a conventional arthroscope, as it is also used in knee joint endoscopy. Here, the inner synovial layer can be partially removed.
By removing this sliding layer, the inflammation can be contained in many cases. The patient not only benefits from the reduced scarring that results from this minimally invasive procedure, but also enjoys the functional advantages of the remaining parts of the sliding layer. However, the standard procedure for surgical treatment of bursitis trochanterica is still bursectomy.
Here, the inflamed bursa is removed in an open surgical procedure. However, the larger surgical field also leaves larger scars and the time of protection after the operation is much longer than with bursoscopy. Finally, the loss of function of the bursa due to its complete removal can have a negative effect on the joint’s ability to bear weight.
Bacterial inflammation of the bursa is a clear argument against surgery. Due to the danger of infection, surgery is not allowed in this case. The same applies to bursitis trochanterica, which occurs as part of a rheumatic disease with simultaneous inflammation of the hip joint.
A basic pillar of the therapy of a bursitis trochanterica is the adequate protection of the affected anatomical structures. If sporting activity is maintained despite the disease, it is possible that the clinical picture may progress further or the healing process may be considerably delayed. This is particularly true for running sports where the hip region is subject to great stress.
However, it should be noted that too much rest or even immobilization of the affected limb can also have negative effects on the stability of the joints or the status of the muscles. Further diseases can be the result. Although bursitis trochanterica also occasionally occurs in cyclists, cycling can be a way of compensating for movement and strengthening muscles, bones and joints while taking care of the limb.
Here it depends on the patient, who should listen to the signals of his body. If pain persists while cycling, we strongly advise against it. Training on a bicycle should also be done in a moderate way.
Too much endurance and stress could worsen the clinical picture. As already mentioned, physical rest is of great importance for the therapeutic success of a Bursitis trochanterica. The disease is mainly caused by excessive strain on the hip joint, which is especially the case in running sports.
Runners should refrain from jogging during the course of the disease in order to positively influence the course of the disease. If this is absolutely not possible, an attempt should be made to switch at least temporarily to activities with less stress. Nordic walking offers an alternative here.
Affected persons should discuss any kind of physical activity with their treating physician. If, as a result of incorrect strain, the hip joint is frequently inflamed by bursitis, it may be advisable to measure the legs and analyse the run. This type of incorrect loading can often be compensated by suitable shoes and/or insoles.
If bursitis occurs especially after participation in sports that are particularly hard on the joints, such as wrestling or bodybuilding, these sports should be avoided in the future and replaced by sports that are easy on the joints, such as swimming or cycling. In general, it is important not to give up sports completely after an inflammation, but to optimize the chosen sport. On the one hand, it is important to pay attention to the sequence of movements and on the other hand, it is important to consider how to relieve the hip joint without putting additional strain on the knees, for example.
At the first signs of a new bursitis of the hip joint, you should also start to take it easy. Regular and correctly executed sport can also protect against a renewed inflammation in the long run. Particular attention should be paid to regular stretching exercises as well as exercises to strengthen the muscles, as this relieves the joint by strengthening the muscles.
Good physiotherapy can also be useful during such strengthening exercises of the surrounding musculature, especially if the bursitis occurs more frequently. To prevent bursitis trochanterica, non-steroidal anti-inflammatory drugs should not be taken, as they primarily take away the pain, but do not eliminate the cause of the disease. Especially patients who have frequent stomach complaints should avoid this type of pain medication or at least take it only in combination with a preparation for stomach protection.
If bursitis of the hip joint occurs regularly in children, a movement and gait analysis should first be carried out to analyse the child’s movements in order to rule out the possibility that the inflammation is caused by a wrong sequence of movements. If this is still the case, the children can learn the correct sequence of movements through therapy in order to avoid further bursitis in the future.