Where is the greater trochanter of the femur? Hip pain - treatment

Nature has created it in such a way that the muscles that provide motor activity in the hip joints lengthen and shorten. At the same time, their active friction against neighboring structures is observed - muscle groups, tendons, as well as bone elements. Due to various negative factors, an inflammatory process can form in one of the three periarticular bursae, for example, trochanteric bursitis of the hip joint.

In the practice of specialists, such a pathology occurs often, since this joint bears a significant load in the life of every person. Severe pain symptoms and significant limitation of motor activity force people to seek medical help.

Inflammation of the trochanteric bursa

Reasons

The pathology is especially widespread among athletes, for example, sprinters. As training becomes more difficult, soft tissue friction increases, which creates a predisposition to injury.

Risk factors are:

age-related changes in the body;
a sharp increase in weight parameters;
active lifestyle;
presence of negative habits.

Overweight

Analysis of the activities of traumatologists allows us to identify the following common causes of hip bursitis:

various injuries - serious bruises caused by a fall or an external blow, complicated fractures, for example, with displacement of bone structures;
congenital anomalies in the structure of bone elements, for example, the length of one lower limb is greater, which leads to a significant distortion, with further irritation and inflammation in the area of the joint capsule;
acquired pathologies - various arthritis, gouty lesions, arthrosis;
physical overload associated with work or chosen lifestyle;
hip bursitis is a constant companion of athletes, runners, and sports cyclists;
a sharp and significant increase in the previously usual load on the joints, for example, the need to move to the top floor of a house that is not equipped with an elevator, gaining more than 10-15 kg during pregnancy.

Heavy fall

During the consultation, the patient can often indicate the root cause that provoked the appearance of unpleasant manifestations of bursitis. Further diagnostic examinations will only confirm his version.

Symptoms of the disease

A typical complaint of a patient with suspected trochanteric bursitis is the absolute inability to lie on his side. This causes him to experience a significant increase in pain impulses in the affected hip. Moving up the stairs and walking for a long time also seems difficult.

Unpleasant sensations may grow slowly or develop suddenly. In the latter case, it is possible to link them with trauma. Some patients indicate that at this moment they could clearly distinguish a peculiar click in the hip joint.

As the pathology progresses and in the absence of adequate therapeutic measures, the intensity of pain impulses decreases. But their localization is expanding - it can cover the entire thigh. At rest, the discomfort decreases somewhat, but during the hours of night rest it increases - it is difficult for the patient to roll over to the side of the inflammatory focus.

Pain in the hip area

A physical examination by a specialist reveals pain in the projection of the greater trochanter of the femur - movements in the position of pronation and adduction of the hip are quite difficult. Other symptoms of inflammation - temperature fluctuations, tissue swelling - are much less common if there are other complications of the pathology.

Diagnostics

In addition to a thorough history taking and physical examination, the specialist recommends other diagnostic measures to confirm the preliminary diagnosis:

X-ray of the hip joint area allows you to exclude fractures of bone structures and identify the presence of calcifications in the periarticular soft tissues or osteophytes;
Modern methods include CT and MRI - signs of inflammatory lesions of the trochanteric bursa and the accumulation of pathological exudate in it are revealed;
It is possible to perform an ultrasound for a thorough examination of soft and hard joint structures, not only in a static position, but also when moving in them.

Ultrasound diagnostics

Only the completeness of the information obtained after carrying out the above diagnostic procedures allows a specialist to conduct an adequate differential diagnosis and make a full diagnosis.

Treatment

Pathology requires an integrated approach to prescribing therapeutic measures. In addition to creating functional rest for the hip joint and using anti-inflammatory drugs, treatment of bursitis includes various methods of physiotherapy, exercise therapy and folk remedies.

Physiotherapy session

At the initial stage of the onset of negative symptoms, conservative therapy is recommended:

ensuring maximum rest for the affected joint - correction of physical activity, use of assistive devices when moving;
taking anti-inflammatory medications and modern analgesics recommended by a specialist, if there is no effect from oral use, perhaps their intra-articular administration;
as inflammatory manifestations are relieved, various methods of physiotherapy are prescribed - ultrasound, electrophoresis, heating;
In order to optimally improve tone in muscle groups and fully develop the inflamed joint, exercise therapy complexes are performed - exercises are selected individually, based on the severity of the lesion and the person’s functional capabilities.

Anti-inflammatory drug Celebrex

If pain and limited mobility in the hip joint persist, specialists decide on the need for surgical intervention.

Its essence is to weaken the tension of the iliotibial structures, with possible excision of the joint capsule. The prognosis is usually favorable.

Traditional medicine

As additional measures in the treatment of trochanteric bursitis, it is quite possible to use traditional medicine recipes:

Pour 20 g of carefully crushed shoots of golden mustache into 200 ml of boiling water, after boiling for 5-7 minutes, stand under the lid for 45-60 minutes, filter - apply as a compress every day before a night's rest. Course duration is 20–25 days.
Heat a handful of flax seeds over moderate heat, wrap them in linen cloth and apply to the thigh above the source of pain impulses. After cooling, cover with a warm scarf. It is recommended to perform before bedtime. The course is at least 10–14 days.
Cut leaves from a five-year-old Kalanchoe plant and place in the freezer for 1–2 days. Then remove and beat thoroughly. Apply the resulting mass to the inflamed joint, place a film and a warm scarf on top. Repeat the procedure for 7–10 days until the pain subsides.

In addition to healing compresses, traditional healers recommend taking anti-inflammatory decoctions - St. John's wort, chamomile, yarrow, burdock rhizome, and celery seeds bring relief.

Wherever bones, tendons, or ligaments move and rub against each other, especially in the joint area, the points of contact are cushioned by small fluid-filled sacs called bursas. The bursae are lined with special cells called synovial cells that produce a fluid rich in collagen and protein. By reducing friction, each of these bags (there are about 150 of them in the body) helps the joints work, smoothly providing the necessary range of motion. The bursa allows for multi-vector movements in joints such as the shoulder, elbow, knee, femur, and ankle. Inflammation and swelling of the bursa is called bursitis.

Causes of bursitis

Excessive stress on the joint or injury, as well as prolonged stress, can cause inflammation of the periarticular bursa. The bag fills with excess fluid, which causes pressure on the surrounding tissue. The immediate first sign of bursitis is pain, often accompanied by redness, swelling and tenderness. This is a distinguishing feature of bursitis as opposed to tendinitis, which is inflammation of the tendon where the tendon of the muscle attaches to the bone. Age plays a certain role in the occurrence of bursitis, and the shoulder joint, which has the greatest range of motion among all joints, is most often susceptible to bursitis in older people. As a rule, pain from bursitis in the shoulder occurs after sleep and gradually regresses during the day (pain is usually localized in the upper part of the shoulder). Other areas where bursitis most often occurs are the area of the elbow joints, the femoral joints of the knees and the area of the thumb.

The main causes of bursitis are trauma, infections and rheumatological diseases.

Injury

Trauma can be both a provoking factor and directly lead to the development of bursitis.

Often develops due to the characteristics of a person’s work. Heavy physical work involving prolonged, repetitive, heavy work. The most common cause of chronic bursitis is a minor injury, such as to the shoulder when throwing a ball. Or, for example, prepatellar bursitis occurs from prolonged kneeling while washing floors.

It is also possible to develop acute bursitis from a blow, for example to the knee, which leads to the accumulation of blood in the bursa.

Infections

The bursae are located close to the surface of the skin and are often susceptible to infection as a result - such bursitis is called infected. The most common microorganism that causes bursitis is staphylococcus. People with weakened immune systems (diabetes patients, chronic alcoholics, patients taking corticosteroids for a long time) are most susceptible to infected bursitis. In 85% of cases, infected bursitis occurs in men. Rheumatological conditions.

Rheumatological diseases

In various rheumatological conditions, secondary inflammation of the bursae is possible. In addition, diseases such as gout or pseudogout due to the deposition of salts in the bursa can cause the development of bursitis.

Symptoms

Common symptoms of bursitis include:

Pain, inflammation, and swelling in the shoulder, elbow, hip, or knee, especially noticeable when straightening the joints.
Stiffness or decreased range of motion in a joint with or without pain.
Muscle weakness due to pain. may cause pain and tenderness in the area of the affected bone or tendon. The bags may increase in size, which may cause difficulty in movement. As a rule, bursitis occurs in the area of the shoulder, elbow, knee and hip.

Shoulder

In the shoulder, the subacromial bursa (subdeltoid bursa) separates the supraspinatus tendon from the underlying bone and deltoid muscle. Inflammation of this bursa is usually the result of injury to surrounding structures, usually the rotator cuff. This condition limits the range of motion of the shoulder, leading to "impingement syndrome" and is characterized by pain in the front and side of the shoulder. Discomfort is caused by raising the arm above the head and putting pressure on the shoulder.

The pain intensifies at night, the range of motion in the shoulder decreases and pain appears in certain areas.

Elbow

Bursitis at the tip of the elbow (olecranon) is the most common form of bursitis.

Pain may increase in a bent elbow as pressure on the bursa increases.
This type of bursitis most often has a post-traumatic nature and can be associated with both direct trauma and excessive rotation and flexion of the elbow (for example, when painting).
Infection also occurs quite often with this type of bursitis.

Knee

Prepatellar bursitis anterior kneecap. Swelling on the front of the kneecap can be caused by chronic trauma (such as from kneeling) or a blow to the knee. The swelling may appear within 7-10 days after a single blow to the area, usually from a fall. Prepatellar bursitis is also called priest's knee or carpet cleaner's knee.
Popliteal bursitis located in the area where the three main tendons of the inner part of the knee are located. This type of bursitis occurs most often in patients with arthritis and these are usually middle-aged and overweight women. Popliteal bursitis manifests itself as pain when bending the knee and at night. Moreover, pain at night forces patients to sleep in certain positions in which the pain becomes less. In addition, this bursitis is characterized by an increase in pain when climbing stairs, possibly radiating along the inner surface of the thigh. Popliteal bursitis is also common among athletes, especially long-distance runners.

Ankle

Ankle bursitis occurs when the bursa under the Achilles tendon behind the heel becomes inflamed. Most often caused by local trauma associated with wearing ill-fitting shoes (often high heels) or prolonged walking

This bursitis can also be a consequence of Achilles tendonitis.

Bursitis in this part of the body often occurs as a consequence of excessive stress in young athletes, speed skaters, and in female teenagers who begin to wear high-heeled shoes. The pain is usually localized at the end of the heel and increases with movement of the foot.

Buttocks

Ischiogluteal bursitis(Ischiogluteal) is caused by inflammation of the ischial bursa, which is located between the base of the pelvic bone and the large buttock muscle (musculus gluteus maximus). Inflammation may be due to prolonged sitting on a hard surface or cycling. Ischiogluteal bursitis is also called weaver's disease. Pain occurs when sitting and walking.

There may be soreness in the pubic bone area, which gets worse when bending and stretching the leg.
The pain may radiate down the back of the thigh.
When pressure is applied to the area of the inflamed bursa, acute pain appears.
The pain is worse when lying down with the hips passively flexed.
It may be difficult to stand on tiptoes on the affected side.

Hip

Iliopsoas muscle bursitis. This bursa is the largest and is located deep in the tissues of the hip near the joint. Bursitis in this location is usually associated with problems in the hip such as arthritis or hip injury

Pain from iliopsoas bursitis is localized in the anterior thigh, radiating to the knee and increasing with hip extension and rotation. ?Extension of the hip while walking causes pain so much that you have to shorten your step and limit the load on the leg. Possible pain in the groin area. Sometimes an enlarged bursa may resemble a hernia. Sensations such as tingling or numbness are also possible if sensory nerves are compressed by an enlarged bursa.

Acetabular bursitis(bursitis trochanteric) is located in the upper part of the femur and occurs, as a rule, in overweight, middle-aged women. Acetabular bursitis manifests itself as pain in the lateral thigh radiating to the buttocks or knee. The pain intensifies when moving local pressure or stretching the leg. The pain gets worse at night and prevents you from sleeping on the affected side. Considering that bursitis can be infectious and treatment with antibiotics or puncture of the bursa will be necessary, it is necessary to seek medical help in the following cases.

Presence of pain in the joint for more than a few days.
Limitation of mobility in the charter.
The presence of swelling that does not disappear after taking NSAIDs.
Increased temperature in the presence of pain in the joint.
Areas around the joint that are hotter to the touch or red.
Areas of pain in the joint area.

Diagnostics

The diagnosis of bursitis is made based on a combination of symptoms, clinical manifestations, medical history and instrumental diagnostic methods. The medical history allows us to determine the presence of concomitant somatic pathology.

Certain diagnostic procedures may be prescribed to rule out other causes of pain. They include the following diagnostic procedures:

Radiography allows visualization of the presence of osteophytes or arthritis.
Analysis of the punctate (microscopy), which was obtained as a result of puncture of the enlarged bursa, allows us to exclude gout and the presence of infection. Bursitis in the knee and elbow are most likely to become infected.
Blood tests can help rule out rheumatologic diseases (such as rheumatoid arthritis) and metabolic diseases (diabetes mellitus).
MRI may be prescribed if detailed visualization of the morphological picture is necessary.

Treatment

Although bursitis is usually self-limiting and disappears after a few days or weeks, steps should be taken to reduce stress or trauma. There are patients who prefer to endure pain, but this can lead to the development of chronic bursitis and the formation of calcium deposits in the soft tissues, which ultimately leads to limited mobility in the joint.

The first step is usually medication. NSAIDs can reduce pain and inflammation. It is also possible to use steroids for a short course (taking into account the presence of somatic diseases). For infected bursitis, a course of antibiotics is necessarily prescribed.

Puncture of the inflamed bursa allows you to aspirate excess fluid and reduce pressure on surrounding tissues. Injecting anesthetics along with steroids into the inflamed bursa helps reduce the inflammation.

Physical therapy (ultrasound or diathermy) can not only reduce the discomfort and inflammation of bursitis, but can also relax tight muscles and relieve stress on the nerves and tendons. In addition, it is possible to use local cold exposure or modern cryotherapy techniques.

Sometimes, with persistent bursitis and pain, surgical removal of the inflamed bursa is recommended.

Prevention of bursitis is the elimination of stress that led to the development of bursitis. Wearing orthopedic devices is often recommended, especially if the work involves a certain risk of traumatic movements. Exercise therapy also allows you to optimize the functioning of muscles and ligaments.

Performing their main function - contraction and relaxation, muscles rub against bones, tendons and each other. To dampen this friction in the body, there are specially designed synovial bursae - bursae.

During the inflammatory process, an inflammatory fluid is formed in the bursae - exudate. Under the influence of unfavorable factors, bursitis of the hip joint develops, the symptoms of which are intense and acute pain.

As the disease progresses, the pain becomes muted and spreads throughout the body.

Hip bursitis must be treated promptly

– an orthopedic disease in which the synovial periarticular bursa becomes inflamed. The bursa is a cavity located around the circumference of the joint and filled with fluid. Bursitis can develop in the trochanteric, ischial and iliopectineal bursae of the hip joint.

Trochanteric bursitis

On the thigh bone there is an external protrusion, the so-called. the greater trochanter, to which the muscles of the hip joint are attached. The greater trochanter is in turn covered by a synovial bursa.

Sometimes, due to its irritation and inflammation, bursitis of the greater trochanter of the femur develops.

Iliopectineal bursitis

On the inner side of the femur there is the following synovial bursa: iliopectineal or iliopsoas. Pain with this type of bursitis is localized in the groin area when the hip is extended. It is less common than trochanteric bursitis.

The type of hip bursitis depends on the location of the inflammation

Sciatic bursitis

The ischial periarticular bursa is located near the ischial tuberosity at the site of muscle attachment. For this reason, pain is activated when the hip flexes.
Trochanteric bursitis is most often diagnosed.

Causes of the disease

In most cases, the “culprits” of hip bursitis are considered to be all kinds of injuries and subsequent complications after them.

Most often, the disease is diagnosed in older women and middle-aged female athletes, in particular runners.

Risk factors causing bursitis:

Heavy regular loads on the hip joint - running, cycling, climbing stairs, prolonged standing;
Sedentary lifestyle;
Spinal diseases, incl. arthritis, scoliosis, lumbar spine;
Congenital anomalies - unequal leg lengths also provoke irritation of the synovial bursae, if one leg is 3-4 cm or more longer than the other;
Rheumatoid arthritis;
Deposition of calcium salts, so-called. "bone spurs" Spurs, or osteophytes, occur in the area of the tendons of the greater trochanter of the femur;
Previously performed operations on the hip joint;
Hypothermia;
Excess weight.

Signs of hip bursitis

Acute pain is the leading symptom of the disease. The localization of pain depends on the location of the inflamed synovial bursa.

An inflamed bursa causes severe pain

As the disease progresses, the nature of the pain changes from intense to dull.

The patient cannot lie on the affected side, climb stairs, walk for long periods, or squat.
Additional symptoms include:

Painful round swelling at the site of joint damage;
Swelling around the bursa;
Increase in temperature, in rare cases up to 40 ° C;
Skin hyperemia;
Weakness and malaise.

Diagnostics

Difficulties in diagnosing hip bursitis are associated with the deep location of the joint and its covering by muscles. For this reason, testing is based on pain analysis and special x-ray studies.

The doctor, conducting a complete objective examination, analyzes the nature and location of pain, the time and place of its occurrence.

When applying pressure - palpation, the specialist uses his hands to determine the position and place where the pain reaches its maximum.

During the examination, the doctor performs Ober's test

A positive Ober test (leg abduction) may indicate tension in the iliotibial band.
To avoid pathologies and injuries, joint scanning and MRI are prescribed. X-ray examination will be able to show areas of ossification in the soft tissues, and ultrasound will show the presence of excess fluid in the bursa.

Treatment

Drug treatment

In the treatment of hip bursitis, it is important to prevent the chronic stage of development of the disease, and not just relieve inflammation.

Their action is aimed at relieving pain and inflammation. A competent combination of glucocorticoids with local anesthetics is an effective tool for treating bursitis of the trochanteric bursa of the hip joint.

Physiotherapy for bursitis brings good results

In non-advanced cases, therapy is carried out on an outpatient basis, because the above-described combinations of drugs are administered directly into the defective synovial bursa. Among the methods of physiotherapy, electrophoresis and ultrasound bring a therapeutic effect.

Compresses from medicinal plants

Such compresses have anti-pain and anti-edematous properties. For this purpose, in the treatment of hip bursitis, preparations of calendula, plantain, pine buds and sage are reliable helpers.

In cases where the underlying cause of bursitis is trauma, biologically active complexes are prescribed.

During the rehabilitation period, bee products and medicinal herbs restore normal microcirculation of blood flow at the site of damage to the synovial bursa.

Herbs and honey improve blood circulation in the joint

The action of the complexes is adjusted to improve endurance, performance and saturation of the joint with valuable minerals, vitamins, amino acids and enzymes.

Treatment by surgery

It is used infrequently when conservative therapy has not had the desired effect, and pain and inflammation progress.

The most popular is arthroscopic bursa removal, in which the hip joint and its functions are not affected.

This type of surgery is less traumatic due to the small size of the incisions.

Arthroscopy for hip bursitis allows the patient to quickly get back on his feet

The rehabilitation period is also faster and less painful than with conventional operations.

Methods for preventing bursitis

To prevent pathologies of the hip joint, introduce into your diet more foods rich in fluoride and calcium. Train your hip joint with exercises to strengthen your hip abductors.
You will find exercises for the hip abductors in the video.

And don’t forget to give your body proper rest after standing work.
Basic methods of preventing bursitis will help prevent trochanteric bursitis of the hip joint, the treatment of which will deprive you of your usual life for some time:

Maintaining muscle tone;
Moderate physical activity;
Weight control;
Active lifestyle;
Refusal to lift heavy objects.

Considering all of the above, when asking the question “How to treat bursitis of the hip joint?”, it is time to boldly say that the prognosis with an effective conservative method is very, very favorable.

Skillful a combination of medications will eliminate the symptoms of the disease in a week, and surgical intervention will help in more severe cases with minimal trauma.

Bursitis is an inflammation of the joint lining. It acts as a shock absorber during movements and reduces friction during movements in the joint. The femur has a protrusion called the greater trochanter. Muscles are attached to it, without which active movements in the thigh are impossible. The bursa covers the greater trochanter, its inflammation leads to restrictions in movements in the hip joint and the appearance of sharp, unpleasant symptoms.

Trochanteric bursitis of the hip joint develops as a result of irritation of the joint capsule, subsequent inflammation. Inflammation of the tendons of the gluteus medius and minimus muscles develops in the places of their attachment to the greater trochanter. At the same time, the nearby mucous bursa (trochanteric bursa) becomes inflamed. This inflammation is a common cause of hip pain.

Trochanteric bursitis of the hip joint often complicates the course of osteoarthritis. More often affects women after forty years. Elderly people (over 60 years of age) are at risk of developing the disease. The disease manifests itself with pain that radiates along the outer surface of the thigh.

Pain occurs in the greater trochanter area. If it is not removed, it will bother you during physical activity and during the rest period. This greatly worsens the patient's quality of life.

Risk factors for trochanteric bursitis

Women in middle and old age are more often predisposed to the disease. Predisposing factors of the disease:

Hip injury. Often occurs when falling on a joint. As a result of a blow to a corner, with prolonged standing in a standing position, the mucous bursa of the greater trochanter is irritated, which contributes to inflammation.
Intense sports activities.
Endoprosthesis replacement surgery. The disease is caused by a postoperative scar. It stretches the soft tissues, irritation of the trochanteric bursa occurs.
Sedentary, sedentary lifestyle.
Static changes in the spine, its curvature.
Hypothermia.
Asymmetry of the lower extremities associated with their unequal length. This causes stress on the joints.

Trochanteric bursitis occurs due to increased friction between the trochanteric bursa and the greater trochanter. This friction of the bag increases because the joint does not produce enough intra-articular fluid. The joint degrades, its cartilage tissue changes.

Symptoms of trochanteric bursitis

The main symptom of bursitis is pain. Spreads along the outer surface of the femur. Sometimes it is very burning. The patient cannot lie on the injured side. The pain worsens at night, and the patient’s healthy, normal sleep is disrupted. Painful symptoms intensify when climbing stairs or rotating the hip.

A swelling is palpable in the area of the trochanter of the femoral bursa. When pressing on it, the pain intensifies. The rotation of the joint is not impaired. Trochanteric bursitis is characterized by the fact that when lying down on the affected leg, the pain intensifies. This deprives a person of proper sleep. Soreness can radiate downward, localizing on the lateral surface of the joint.

The appearance of pain when walking due to irritation of the joint capsule is typical. In the first minutes of walking the pain is stronger, then it subsides. If you cross your legs while sitting, the pain intensifies. The appearance of vegetative-vascular disorders is possible.

External examination of trochanteric bursitis of the hip joint shows unchanged contours. This is explained by the fact that the trochanteric bursa is securely covered by the gluteal muscles and is located deep in the subcutaneous adipose tissue.

Acute form of the disease

The acute form of trochanteric bursitis of the hip joint is manifested by the fact that a person begins to be bothered by an attack of severe, rapidly growing pain. Localization - in the area of the greater trochanter of the joint. Active movements in the joint are painful and noticeably limited. Symptoms intensify when the hip is abducted. Passive movements in the hip joint are painless, free, and do not cause discomfort.

Palpation of the articular capsule reveals a painful, dense formation in the area of the greater trochanter. It leads to additional limitation of active movements. The patient's body temperature is often low-grade. The inflammatory process in the body leads to an increase in the erythrocyte sedimentation rate.

Acute symptoms of trochanteric bursitis subside within a few days, rarely weeks. In some patients, trochanteric bursitis takes on a protracted course - the disease becomes chronic.

Chronic trochanteric bursitis

Chronic trochanteric bursitis is often a complication of an acute process. The main reason for its appearance is improper treatment of acute bursitis and late consultation with a doctor.

Features of the chronic form of the disease are less pronounced symptoms of the disease. The pain is not severe or absent. X-rays and ultrasound show areas of change in the area of the greater trochanter of the hip joint. Chronic bursitis occurs in a less pronounced form - this does not mean that it does not need to be treated. A constant chronic process in the joint capsule affects the health of the diseased joint.

If trochanteric bursitis is not treated, the patient is at risk of disability, and movements in the joint will gradually worsen.

Features of trochanteric bursitis

Trochanteric bursitis has characteristic features:

The pain is severe, deep, sometimes burning, located on the lateral surface of the joint. Sometimes it looks like a radicular one.
Pain occurs when walking on a flat surface, and intensifies while climbing stairs, squatting, or moving your legs to the side.
Pain reduction occurs in a calm state.
At night, pain intensifies, especially if a person lies on the side affected by inflammation.
Palpation of the joint increases pain.
The pain syndrome is intermittent.

Diagnosis of trochanteric bursitis

The diagnosis is based on instrumental techniques:

X-ray examination. Able to detect changes in bones and joints in the area of the greater trochanter.
Scintigraphy. Changes in the superolateral region, greater trochanter, indicate bursitis or tenosynovitis.
Magnetic resonance imaging is the latest word in the diagnosis of hip disorders. MRI allows you to diagnose soft tissue pathologies, changes in muscles, bones, and salt deposits. Magnetic resonance imaging is recommended for all patients with indications for surgical treatment of pathology.
Ultrasound examination is a highly effective way to determine the presence of pathology in the hip joint. The picture of the disease obtained during ultrasound diagnostics makes it possible to prescribe precise, effective treatment for the joint.

Diagnostic methods make it possible to resolve the issue of treating bursitis.

Features of disease treatment

Treatment for bursitis should begin as early as possible. The effectiveness will be greater, the risk of complications will decrease. Conservative treatment of the disease is most accessible. It is recommended to limit active movements in the affected leg. Rest is necessary for a speedy recovery. Avoid excessive activity.

Non-steroidal anti-inflammatory drugs relieve inflammation. Voltaren, Diclofenac, Ibuprofen are often used. They relieve inflammation and swelling. The use of NSAIDs has advantages - they quickly relieve unpleasant symptoms and help improve active movements.

Physiotherapy is an important link in the treatment of trochanteric bursitis of the hip joint. Typically used, depending on the case, heat, cold, UHF. Reduces swelling and inflammation during bursitis, promotes a speedy recovery.

Immediately after a joint injury, cold is necessary. During chronic inflammation of the hip joint, cold will be harmful; the patient needs exposure to heat. The use of physiotherapeutic procedures is permissible after consultation with a doctor.

If there is inflammatory fluid in the joint mucosa, its removal is indicated. This is done using a puncture. It is not dangerous for the joint. The extracted liquid is used for laboratory testing for diagnostic purposes. Intra-articular injections are indicated. The injections contain anti-inflammatory and analgesic drugs. The effect is long lasting. After injections, patients are advised to sleep on a pillow under their buttocks. In rare cases, the injection is repeated.

Treatment for exacerbation of the disease

In case of exacerbation of the disease, treatment measures are reduced to the following measures:

Pulse magnetotherapy: 15 minutes daily for ten days;
Infrared laser therapy on the affected area of the greater trochanter, lasting 10 days;
decimeter wave therapy;
Percutaneous electroanalgesia for 15 minutes, 10 procedures.

After reducing the intensity of the inflammatory process, the patient is prescribed treatment:

Ultrasonic phonophoresis using hydrocortisone;
Applications with naphthalan;
Shock wave therapy;
Local cryotherapy using dry air.

What you need to know about surgical treatment

Surgical treatment is used if conservative treatment does not produce results. During the operation, the doctor makes an incision in the trochanteric bursa. She is removed and the greater trochanter is examined. Irregularities on it are removed, the surface is smoothed. The skin is sutured. The wound is covered with a sterile bandage.

Rehabilitation measures are aimed at quickly restoring the functionality of the affected joint. In the first days of the postoperative period, exercise therapy is aimed at relieving swelling and pain. Then special exercises are prescribed to develop the muscles. The duration of exercise therapy in the postoperative period is up to four months. The duration of treatment is determined by the doctor.

Prevention of trochanteric bursitis is aimed at intensifying physical exercise, combating bad habits, and diet. It is important that the person does not stand for a long time. Elderly people are advised to undergo physiotherapeutic procedures and relax at a resort.

ICD-10 code: M70.6 (Bursitis of the greater trochanter of the femur), M70.7 (other bursitis of the hip)

Hip bursitis is a disease that is associated with inflammation of the contents of the synovial bursa (bursa).

A bursa or joint capsule is a sac filled with a gel-like liquid that acts as a shock absorber and reduces friction between joints.

Hip bursitis can affect the ischial, iliopectineal, or trochanteric bursa of the hip joint.

Causes of the disease

Several synovial bursae are located near the hip joint, since this part of the skeleton is subject to heavy load. The causes of all hip bursitis are approximately the same:

strong and regular physical activity on the hip joint;
intense sports training;
hypothermia;
various diseases, congenital anomalies and pathologies (arthrosis, arthritis, salt deposits, different lengths of limbs);
obesity;
sedentary lifestyle;
previously performed operations on the hip joint, previous injuries and injuries;
old age;
infectious lesion of the joint capsule;
disruption of metabolic processes.

Main types of hip bursitis: characteristic symptoms

The symptoms of the disease depend on the location of the inflamed joint capsule, since in each case they are different.

Sciatic bursitis

The ischial joint capsule is located in the place where the bony ischial tuberosity connects with the muscles. When the sciatic bursa becomes inflamed, a person experiences symptoms of severe pain in the upper thigh, which increases even with minimal exertion.

Ischial bursitis of the hip joint often manifests itself when trying to bend or straighten the joint, when climbing an inclined surface, or when sitting for a long time on something hard.

Acetabular (trochanteric)

The trochanteric joint capsule is located on the outside of the thigh. The disease often affects this particular part of the hip joint, causing trochanteric bursitis. With acetabular bursitis, severe pain appears in the outer part of the thigh, so pain symptoms occur even when lying down on the injured side.

It becomes almost impossible to sleep. When climbing stairs, a burning pain occurs in the leg and hinders a person’s movements. Trochanteric bursitis occurs 2 times more often than other bursitis of the hip joint. This disease is often diagnosed in middle-aged and elderly women, as well as in athletes.

Iliopectineal

The iliopectineal bursa is located on the inside of the hip joint. If it is inflamed, then the pain spreads to the front, inner sides of the thigh and radiates to the groin.

General symptoms:

Burning sensation.
Sharp and gradually increasing pain in the hip joint. When inflammation just begins, severe pain occurs; the pain point is located above the inflamed bursa. As bursitis develops, the pain gradually moves from acute to aching, while covering an increasingly larger area.
Lethargy and apathy due to constant pain, loss of performance.
Sleep disturbance.
It is impossible to fully flex and extend the lower limb.
Discomfort when climbing stairs after a long walk.
Suppuration when infection enters the bursa.
Increased body temperature.
Swelling. Appears as a result of injury. At first the tumor becomes visible, but gradually it becomes smaller and disappears.

If the above symptoms appear, then this is a reason to consult a doctor. After all, the sooner treatment begins, the faster relief will come.

Complications of the disease

Hip bursitis, if left untreated, can become chronic.

In this case, all the capsules of the hip joint become inflamed, which leads to limited mobility. To prevent complications even after surgery, it is necessary to strengthen the immune system, solve the problem of excess weight, spend more time in the fresh air, walking and strengthening the lower limbs, and give up bad habits.

If sciatic, iliac, trochanteric bursitis becomes chronic, the pain gradually subsides and becomes less pronounced, and a small swelling of a round shape and soft consistency appears at the location of the affected bursa. In the chronic form, the function of the joint is preserved.

When the bursa becomes infected with microbes, purulent bursitis of the hip joint develops. There is sharp pain when trying to move the hip to the side. A swelling forms on the outside of the thigh. It is impossible to fully straighten or bend the hip, so it is constantly in a semi-flexed position.

Diagnostics

The patient undergoes a series of examinations, based on the results of which treatment is prescribed:

Visual inspection and palpation of the painful area of the joint.
Ober's test. This is an additional hip abduction test. If bursitis occurs, then such movement will be extremely difficult and cause severe pain.
X-ray to identify ossified areas.
MRI. Allows you to identify areas of inflammation and accumulation of exudate.

Diagnosis of the inflammatory process in the hip joint is somewhat difficult due to its deep location and covering with muscles. Therefore, it is based on the analysis of patient complaints and x-ray examination. MRI is necessary to identify osteophytes in the periarticular bursa and to exclude the development of arthritis.

Therapy

In case of inflammation of the synovial bursa of the hip joint, the initial goal is to eliminate the pain syndrome. It is necessary to provide complete rest to the sore joint, to minimize the load on it when moving.

Treatment with painkillers and anti-inflammatory drugs is prescribed.

Hormonal medications and local anesthetics are used to relieve pain. In advanced cases, treatment of hip bursitis is carried out in an outpatient setting; it consists of a single injection of potent drugs into the inflamed bursa. If an exacerbation occurs again, then another injection is given.

To prevent relapse of the disease, you should use: natural chondroprotectors that normalize the blood supply to cartilage and joint tissue. Antioxidants that nourish joint tissue and quickly restore blood microcirculation (for example, dihydroquercetin). Dietary supplements based on bee products are useful.

Infectious bursitis must be treated with antibiotics. Treatment of non-infectious bursitis is carried out using an ice compress, anti-inflammatory and painkillers. Sometimes aspiration (pumping out exudate from the bursa) may be required.

Non-infectious bursitis can also be treated with cortisone injections into the bursa area, sometimes along with a pain reliever. This treatment is usually carried out after the aspiration procedure. If there is a large amount of exudate, it is pumped out from the cavity of the bag, and medications are administered there.

After acute inflammation and pain are relieved, physiotherapy is prescribed.

Physiotherapeutic treatment

Ozokerite and paraffin applications.
Microwave therapy.
Therapeutic massage.
Inductotherapy.
Electrophoresis.
Dry heat.

Operation

Surgical treatment is prescribed only if ischial, iliopectineal, trochanteric bursitis does not respond to conservative therapy, inflammation and pain do not go away.

In this case, excision of the joint capsule is prescribed. Arthroscopy is actively used, during which a small incision is made in the thigh and a device is inserted that allows the doctor to operate instruments to remove the bursa.

This operation is well tolerated by patients, the function of the hip joint is not impaired, and after the operation people recover very quickly. Drainage is often used to remove exudate from the inflamed bursa. In severe cases of the disease, a bursectomy is performed, in which the entire joint capsule along with its contents is completely removed.

Prevention

After the operation, a person should undergo a rehabilitation course, which will help him recover faster. The rehabilitation period includes:

constant but moderate physical activity, training the muscles of the lower extremities;
it is necessary to take daily walks, using a cane or special walker;
maximum reduction of the load on the hip joint, limitation of physical activity, which provokes inflammation of the synovial bursa;
body weight control;
if bursitis has developed due to different leg lengths, then special orthopedic devices should be worn;
You should periodically give your legs proper rest.

Most often, hip bursitis responds well to conservative treatment.

The use of anti-inflammatory drugs in combination with anesthetics completely relieves the symptoms of pain and inflammation in 5, maximum 7 days. And prevention will prevent relapse of the disease.