Pain syndrome of the greater trochanter. Trochanteric bursitis of the hip joint

Trochanteritis is an inflammatory disease that affects the trochanter of the femur. This is the highest point of the thigh, to which a large number of tendons and muscles are attached.

At first glance, it is very difficult to distinguish between trochanteritis and a disease such as coxarthrosis (arthrosis of the hip joints). But in about half of the cases in patients diagnosed with coxarthrosis, a detailed examination reveals exactly trochanteritis as the cause of pain. This is by no means a rare pathology, it is just that it is often not recognized.

Important to remember! Trochanteritis responds well and quickly to treatment if it has not become chronic. Therefore, it is necessary to exclude this disease, first of all, with pain in the hip joints.

The essence of the disease

As already mentioned, pathological changes in trochanteritis affect the greater trochanter (trochanter) of the femur (the extreme upper outer point of the thigh) and the tendons that are attached to it. Hence the name of the nosological form of pathology. This inflammation can be caused by both infectious and non-infectious causes.

With trochanteritis, the greater trochanter of the femur becomes inflamed

The main function of the trochanter is that it acts as a site of attachment for a large number of muscle tendons of the gluteal zone and thigh region. Above this bone structure, on top of the muscles under the skin, is a small synovial sac (bursa) that plays a protective role and also facilitates movement in the hip. This anatomical formation is very often drawn into the pathological process and becomes inflamed, developing hip bursitis. Therefore, sometimes you can find another name for trochanteritis - trochanteric bursitis.

Remember! With trochanteritis, the greater trochanter of the femur, the tendons of the muscles that are attached to it, and the synovial sac located nearby become inflamed. The process is most often unilateral, but bilateral lesions can also occur.

According to ICD-10 (international classification of diseases of the 10th revision), this pathology is assigned the code M70.6.

Causes of trochanteritis and its types

Mostly women get sick with trochanteritis, since in men the tendons are initially stronger and more resilient, designed for various kinds of loads. The peak of the pathology is observed during the period of menopausal restructuring, which is associated with the development of osteoporosis, weakening of the tension of the ligaments, and a decrease in their elasticity against the background of a deficiency of estrogen hormones. But the disease is not excluded in younger patients, but this requires a long-term exposure to provoking factors.

As a rule, trochanteritis debuts after a severe overload of the hip joint (long walking, running, carrying heavy loads), and symptoms also appear against the background of colds and other infectious diseases. Sometimes inflammation of the trochanter begins after an injury in the thigh (even a minor one). Very often, patients note that hip pain appeared after they suddenly gained weight, so overweight is also a predisposing circumstance.

With every extra kilogram increases the chance of developing trochanteritis

Risk factors for the development of trochanteritis:

belonging to the female sex;
age (the older the person, the more likely he is to get sick);
systemic osteoporosis;
metabolic and endocrine diseases;
excess body weight;
deforming osteoarthritis;
too active or, conversely, passive way of life;
previous injuries in the hip area;
frequent infectious diseases, foci of chronic infection in the body;
tuberculosis (active or history).

Types of trochanteritis:

A septic, or non-infectious. The most common variant of the pathology, which is based on inflammation due to overload of the tendons that are attached to the trochanter.
Septic, or infectious. Occurs when pathological microorganisms (bacteria, viruses) penetrate into soft periarticular tissues. The infection can get here with the blood in case of common infectious diseases from chronic foci of infection.
Tuberculous. This is a rare form of pathology. It is a separate variant of tuberculosis infection. In this case, not only the greater trochanter and soft periarticular tissues are affected, but also the rest of the bone with the development of osteomyelitis. This is a serious disease that is difficult to treat. It occurs mainly in children.

Symptoms of trochanteritis

Most often, patients with trochanteritis tell the doctor about such a symptom as pain. It occurs in the region of the greater trochanter, which can be easily felt under the skin. The pain intensifies with pressure on this area, with active movements. The pain subsides at rest.

The pain spreads along the outer side of the thigh (in the zone of the riding breeches). But in the case of the transition of the process into a chronic form and the absence of treatment, the pain becomes very intense and disturbs the person even at night, preventing him from falling asleep. You can also note the characteristic symptom of increased soreness when positioned on the affected side.

Important to remember! Unlike arthrosis of the hip joint, with trochanteritis there is no restriction of movement in the hip. Because of the pain, the patient may spare the affected limb, but passive movements are not limited. This can be easily checked by the doctor during the examination.

If the described clinical picture is accompanied by fever, swelling on the outside of the thigh, redness of the skin in this area, then septic or tuberculous trochanteritis should be suspected.

Pain in the thigh area is the main symptom of trochanteritis

Diagnostics

The diagnosis of trochanteritis is exclusively clinical, since there are no specific diagnostic methods. The main clinical criteria for pathology:

pain in the thigh when lying on the side;
pain in the zone of riding breeches when pressing in this zone with a finger on some points;
preserved mobility in the hip joint.

All other additional studies are carried out in order to exclude similar diseases, primarily coxarthrosis.

Diagnostic program:

General analysis of blood and urine, biochemical study, rheumatic tests.
Ultrasound of joints and soft tissues.
In severe cases, CT or MRI is performed.

X-ray of the hip joints can distinguish trochanteritis from coxarthrosis

Treatment of trochanteritis

Treat trochanteritis in accordance with its etiology. First of all, it is necessary to exclude the infectious nature of inflammation, since in this case the therapy is specific. It differs from the treatment of the aseptic form of the disease. Patients are prescribed antibacterial, and in the case of tuberculosis - anti-tuberculosis therapy.

As a rule, with adequately chosen drugs, drug treatment is sufficient. But sometimes complications develop in the form of suppuration, the formation of abscesses and cold leaks in the thigh area. This situation requires surgical treatment. Perform an autopsy and sanitation of all abscesses.

Most often, one has to deal with aseptic trochanteritis, in the treatment of which several methods are used.

Mode

Perhaps this is one of the main principles of successful therapy. A sick limb needs to create complete functional rest. Otherwise, the load will only increase inflammation and pain.

Medical therapy

To eliminate inflammatory changes and pain syndrome, drugs from the group of non-steroidal anti-inflammatory drugs are used. They are prescribed in injections, in tablets, as well as in the form of ointments or gels for external use. Most often resort to the use of drugs such as diclofenac, ibuprofen, aceclofenac, meloxicam, ketorolac, indomethacin, celecoxib. As a rule, 7-10 days of regular administration of these medicines are enough to eliminate the pain.

In severe cases, when pain cannot be eliminated by drugs from the NSAID group, local administration of glucocorticoids periarticularly (into the soft periarticular tissues) is resorted to. This procedure is called a blockade. Long-acting GCS is used for it, for example, Diprospan, Kenalog. Local anesthetics (lidocaine, novocaine) are also added to such injections. As a rule, 1-3 such procedures are necessary to eliminate the pain syndrome.

Hip blockade is an effective and quick way to eliminate pain

Physiotherapy treatment

Among the physiotherapeutic procedures, the most effective for the treatment of trochanteritis are:

laser therapy,
shock wave therapy,
paraffin thermal applications,
magnetotherapy,
phonophoresis with hydrocortisone,
electrophoresis.

This is a special therapeutic technique that was developed specifically for the treatment of pathology of tendons and muscles. Postisometric relaxation consists in the interaction of the doctor with the patient, in which the necessary ligaments or muscles are passively stretched by giving certain positions to the body parts of the sick person.

As a rule, in 90% of cases, for the treatment of trochanteritis, you need to complete a course of 8-10 sessions (20 minutes each) every other day. And that may be enough to heal. The only negative is the waste of time, so patients rarely resort to this treatment method, and absolutely in vain.

Post-isometric relaxation session

Physiotherapy

Gymnastics with trochanteritis is prescribed without fail, but after the elimination of acute pain. Physical exercises can strengthen the thigh muscles, activate blood flow in this area, which contributes to a speedy recovery. It is only important to remember that it is impossible to perform movements that lead to the progression of damage to the diseased tendon. The exercise therapy complex should be gentle.

Alternative treatment

Home folk remedies will help reduce the pain of inflammation of the greater trochanter, but, unfortunately, they do not affect the cause of the disease. Therefore, you should not use folk recipes as the main treatment, they can only be used as an addition to the main therapy.

Thus, trochanteritis is a fairly common, but often undiagnosed disease, which leads to the transition of the pathology to a chronic form and the development of constant pain in the thigh. Often people perceive symptoms such as arthrosis and do not seek help, believing that nothing can be done. This is a very big mistake, since in half of the cases the cause of this pain is inflammation of the greater trochanter of the femur, which responds very well to therapy.

The hip joint is tightly surrounded by muscles and tendons that move it. To prevent friction of the soft articular tissues between themselves and on the bone surface, each tendon is protected by a small bag (bursa), which plays the role of a cushion-shock absorber and a lubricating mechanism: the cells of the inner synovial membrane of each bag secrete a special fluid - synovia, containing collagen and protein.

Usually synovial fluid is released exactly as much as needed, but when the bursa becomes inflamed, the synovium becomes so large that it leads to swelling, pain, and limited mobility in the joint. This phenomenon is hip bursitis.

Disease leads to:

Injuries to the femur from falling and hitting sharp corners.
Long-term dynamic and static loads:
- a ride on the bicycle;
- climbing a mountain or stairs;
- running, especially on inward or outward inclined roads;
- lying on one side, etc.
Deforming, degenerative and inflammatory diseases of both the lumbosacral region and the spine as a whole.
Asymmetry in the length of the lower extremities: even a two-centimeter difference in length causes limping and tension in the hip joint.
Previous operations in the hip joint: osteotomy, insertion of metal structures and wires, arthroplasty.
Rheumatoid, infectious, allergic arthritis.
Bechterew's disease.
Congenital hip dysplasia.
Ossification of the tendons (deposition of calcium salts) and the formation of osteophytes.

There are many tendon bags in the hip joint.

Types of hip bursitis

Basically, hip bursitis develops in three bags:

Spitting:
- at the point of attachment of the gluteus medius, piriformis, upper and lower twin muscles to the greater trochanter.
Iliac-comb:
- in the inner inguinal region of the thigh, where the tendons of the iliopsoas and pectineus muscles are located.
Ischial:
- in the area of attachment of the tendons of the muscles of the back of the thigh (biceps, semitendinosus and semimembranosus) to the ischial tuberosity.

Bursitis of the hip joint should be distinguished from synovitis - inflammation of the synovial membrane surrounding the joint itself - the articulation of the femoral head with the acetabulum.

Symptoms of hip bursitis

Trochanteric bursitis (trochanteritis)

Trochanteric bursitis occurs most frequently, and mainly in female athletes, due to the anatomically wider pelvis, which increases the friction of the tendons in the area of attachment.

The disease is promoted by long-distance running.

Main symptoms:

Sharp, burning pain, radiating along the outer surface of the thigh, aggravated by rotational movements inward (pronation), squatting, climbing stairs.
It becomes impossible to lie on the affected side.
With bursitis of a traumatic nature, the pain is sudden and sharp, traumatic damage may be accompanied by a click.
For other reasons (scoliosis, arthritis, etc.), pain symptoms increase gradually, day by day.

Iliococcipital bursitis

Due to the connection of this bag with the articular cavity, iliopectineal bursitis resembles hip synovitis in its symptoms, which is the main symptom of coxitis (hip arthritis).

Symptoms:

Pain in the thigh, along the anterior inner surface, below the ligaments of the groin.
When the hip is extended, pain increases, for example, at the time of getting up from a chair or lifting the hip.

ischial bursitis

Symptoms:

Pain at the time of hip flexion: when sitting down on a chair or squatting.
Pain also occurs if you sit or lie down for a long time.
The ischial tubercle on the affected side is enlarged.
The pain gets worse at night.

Due to the fact that hip joint bags are not superficially located, but are covered with muscles and adipose tissue, swelling in hip joint bursitis does not have such a vivid clinical picture as the same pathology in other joints.

Diagnosis of trochanteric bursitis of hip joint

The main diagnostic value is an examination by an orthopedist:

So, trochanteric bursitis manifests itself as pain during palpation of the greater trochanter.
With tendinitis of the gluteal muscles, similar pains also occur, but they accompany hip abduction. Pain in trochanteric bursitis occurs during adduction and pronation of the femur.
To differentiate the disease, the doctor lays the patient on a healthy side and performs abduction, adduction and rotation of the diseased hip.

One of the tests is Aubert's test:

The upper leg is bent at a right angle and taken to the side.
Then the legs are extended in the TBS.
Release the leg and observe its adduction.

If adduction does not occur to the end, this indicates tension in the fascia lata of the thigh and its continuation - the ilio-tibial tract (ITT), which starts from the ilium and ends at the condyle of the tibia. PBT tension is a sure symptom of trochanteric bursitis.

Instrument diagnostics is also used:

radiography, magnetic resonance or computed tomography.

On x-rays, areas of tendon ossification near the greater trochanter and osteophytes in the places of their attachment are sometimes clearly visible.

Treatment of hip bursitis

The treatment is mainly conservative, subject to the regime of rest and the removal of those loads that led to inflammation of the bags. More often, temporary anesthesia and exercise therapy are enough:

Non-steroidal drugs are prescribed:
- ibuprofen, piroxicam, naproxen, celecoxib.
With severe severe pain, you can resort to crutches or canes.
When acute pain is stopped, they begin physiotherapy exercises, which include exercises:
- for stretching (scratching) of the fascia lata and tensor of the fascia lata, iliac-tibial tract and biceps femoris;
- to strengthen the muscles of the buttocks.

Physiotherapy treatment

In the physiotherapy of hip bursitis, mainly extracorporeal shock wave therapy is used.

Treatment with a magnetic field, laser therapy, electrophoresis, applications and other methods is most often useless, or plays the role of a placebo.

Since physiotherapy is carried out mainly during the recovery period, it often coincides with remission, in which the pain subsides on its own for a period.

Surgery

Surgical treatment for hip bursitis is used very rarely: the basis for surgical intervention here are much more serious reasons:

hip fractures, dysplasia, deforming arthrosis.

With bursitis, both arthroscopy and wide access operations are practiced.

During arthroscopy, the affected bursa is removed using two small incisions: an arthroscope with a microscopic camera is placed in one, and a surgical instrument is inserted into the other.

The main point of most operations is to loosen the tension of the PBT:

A longitudinal incision is made in the region of the greater trochanter, exposing the iliotibial tract, the tensor fascia lata, and the gluteus maximus muscle.
Then, through the incision in the PBT, they penetrate to the trochanteric bag located under it.
The bag is excised, and an oval-shaped flap is cut out from PBT above the lateral epicondyle of the femur, or a Z-shaped plastic is performed to facilitate tension.

Complications and prognosis

The prognosis for bursitis is favorable, if you do not start the disease and prevent it from moving into the chronic stage.

Of the possible complications:

chronic PBT tension syndrome;
limited mobility, especially internal rotation;
"frozen" hip - with involvement of the joint capsule (adhesive capsulitis).

Prevention of hip bursitis

To prevent hip bursitis, you must:

Avoid prolonged repetitive movements in the hip joint and lumbosacral spine.
For foot pathologies, wear orthopedic shoes.
Engage in physical exercises to stretch and strengthen the thigh muscles.
Maintain optimal weight.

Video: Treatment of bursitis with folk remedies.

Bursitis of the hip joint, first of all, requires conservative treatment, which consists in the modification of physical activity, i.e. limiting any activity that aggravates pain. The doctor prescribes non-steroidal anti-inflammatory drugs to the patient, with which you can relieve pain and stop the development of the inflammatory process. In order to relieve pain in bursitis, effective hormonal preparations are used in their competent combination with local anesthetics.

Treatment of hip bursitis in non-started cases is carried out on an outpatient basis and includes a single injection of drugs directly into the damaged synovial sac. With repeated exacerbation of bursitis and the resumption of pain, the patient may need another injection.

Conservative treatment includes physical therapy. The selection of an effective set of exercises will depend on the course of the disease, however, first anti-inflammatory drugs are prescribed to the patient, and only after that - preventive manipulations (electrophoresis and ultrasound, therapeutic exercises).

In the treatment of hip bursitis, it is very important not only to relieve inflammation, but to prevent the chronic development of the disease. To do this, along with drug therapy, compresses with plantain, sage, as well as calendula and pine buds are used - medicinal plants that have pronounced anti-inflammatory and anti-edematous properties. Other effective means to reduce the recurrence of hip bursitis include:

Osteo-Vit. A modern biologically active complex, an effective natural chondroprotector that ensures the efficiency of recovery processes, as well as the normalization of venous blood supply to the articular and cartilage tissue. The composition of the drug includes vitamins D and B6, which contribute to the normalization of mineral metabolism in the human body. The preparation contains drone brood homogenate, which is a natural source of amino acids.
Dihydroquercetin plus. Antioxidant, the action of which is aimed at nourishing the articular tissue and the rapid restoration of blood microcirculation. With the help of this tool, the cells of the articular tissue are freed from free radicals that impede the regeneration process.
Elton P, Leveton P. Effective biologically active complexes, including bee products, as well as various medicinal herbs, the action of which is aimed at increasing efficiency, endurance, providing the body with essential trace elements, vitamins for strengthening bones, enzymes and useful amino acids.
It is especially important to take these drugs during the rehabilitation period, since with the help of these biologically active complexes it is possible to restore normal blood microcirculation in damaged tissues and blood vessels. The drugs have pronounced anti-inflammatory, anti-edematous and wound-healing properties. This is of particular importance if the underlying cause of hip bursitis is trauma.

Surgical treatment is used by doctors only in rare cases when conservative treatment does not give the desired results, and pain and inflammation persist. In such a situation, the only solution is to remove the damaged synovial bursa, which in no way affects the normal functioning of the hip joint. In modern medicine, the so-called. "arthroscopic" removal of the damaged synovial bag. Such an operation is performed by a small dissection of the thigh area and the internal introduction of an arthroscope - an apparatus that allows the doctor to freely manipulate surgical instruments in order to extract the synovial sac. Such surgery is characterized by a minimum level of trauma for the patient, as well as a less painful course of the recovery period.

Treatment of bursitis of the hip joint by means of traditional medicine, first of all, is effective in terms of reducing the inflammatory process. We can recommend the use of such an absorbable compress: grate 1 tbsp. a spoonful of laundry soap, add 1 tbsp. a spoonful of honey, the same amount of grated onion and mix everything. A clean cotton cloth should be laid on a piece of polyethylene and the prepared therapeutic mass should be laid out. Apply a compress to the inflamed area and wrap with a woolen cloth. It is desirable to apply the compress for 7 days. Before starting treatment, it is recommended to consult with your doctor.

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Causes of trochanteric bursitis

The causes of thickening in the tendons are not exactly understood. The main reason is considered to be an increased load on the joint. However, most often bursitis appears suddenly, for no apparent reason. As noted earlier, the disease occurs due to excessive friction of the bag on the greater trochanter of the femur. Friction occurs during walking or intense movements, during which the fascia of the femur is strongly tensed and moves near the greater trochanter.

When walking on inclined planes or when the legs are of different lengths, the fascia is strongly stretched on the shortened side, because it becomes necessary to raise the back of the pelvis above the permissible level. It happens with every step. Over time, the muscles surrounding the wide fascia of the thigh hypertrophy. The enlarged fascia presses on the greater trochanter and compresses the surrounding tissue. Because of this, the trochanteric bursa is injured, which leads to the appearance of inflammation - bursitis.

The disease often occurs after hip arthroplasty, reviews of which are more often good than bad. The resulting postoperative scar tightens the tissues in the opposite direction. Sometimes the trochanteric bag is damaged by various injuries. Injuries lead to rupture of the tissues of the trochanteric capsule and the ingress of blood into its cavity. The blood accumulating in the bag leads to inflammatory processes. With a chronic inflammatory process, the walls become thicker, lose their elasticity and sliding qualities. This leads to the development of trochanteric bursitis.

The main symptoms and diagnosis of the disease

The first sign of the onset of the disease is pain that occurs at the site of the protrusion of the femur - the greater trochanter. The pain gets worse with walking and movement. In later stages of bursitis, pain may radiate to the lower thigh, causing lameness. If you do not reduce the load on the affected limb, the pain will appear at rest.

The diagnosis of bursitis is made after examination and conversation with the patient, as well as after all the necessary diagnostic measures have been taken. The doctor asks the patient questions about the nature of pain in the thigh, their appearance at certain moments of walking. An x-ray of the hip joints is required. The bag itself will not be visible in the picture, but it will help the doctor assess the condition of the joints. The disease often develops against the background of concomitant pathological conditions in the joints. After injuries or during a chronic inflammatory process, osteophytes can form on the greater trochanter - bone processes that injure the trochanteric bag, supporting the inflammatory process. Based on the x-ray, the doctor can choose the best course of treatment for bursitis. If the osteophytes are large, it would be reasonable to treat bursitis surgically - removal of the osteophyte.

If there is doubt about the correctness of the diagnosis, an anesthetic injection is made inside the bag. If pain after this procedure disappears, the diagnosis is correct.

Treatment of trochanteric bursitis

Treatment of the disease usually begins with simple procedures. Most of the patients do without surgery. For young patients, doctors recommend reducing the load on the affected joint and undergoing a rehabilitation course, which includes exercises to stretch the muscles of the thighs and buttocks. Inflammation should be treated with anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs relieve swelling and pain.

To fully restore the motor functions of the joint, it is necessary to follow the recommendations of a physiotherapist. He will select the optimal procedure for the patient, taking into account the characteristics of his body and contraindications. The use of cold, ultrasound, heating and UHF helps relieve swelling and pain. Using heat or cold is a convenient method to do at home. Cold recommends applying immediately after injury, heat - in chronic inflammatory processes. In any case, the treatment of the disease should be discussed with your doctor.

With the accumulation of fluid in the trochanteric bag, a puncture is made, which is necessary to remove water and perform laboratory tests. During this procedure, in the absence of infectious diseases, a small dose of steroid hormones, such as cortisone, is injected into the trochanteric bag. Steroid drugs quickly relieve inflammation, the anti-inflammatory effect lasts up to several months.

If conservative treatment helps to relieve inflammation, but the pathological processes resume after some time, if movements and daily activities become difficult, doctors offer the patient surgical intervention. An incision is made in the trochanteric bag and its excision. After removing the bag, the surgeon examines the greater trochanter of the femur, the irregularities on it are removed, and the surface of the bone is smoothed. After that, the incision is gradually sutured.

The technique for increasing the large fascia of the femur has been described above. As a result, the tension of the fascia is reduced, the load on the trochanteric bag is reduced. Since in this area it is necessary to ensure the sliding of the fascia lata, a new capsule is formed from the existing tissues. This happens after a certain period of time after surgery. In order for the recovery to take place without difficulty, it is necessary to undergo treatment and rehabilitation.

Rehabilitation for bursitis

Even if surgical treatment of the disease was not required, the patient must perform certain exercises that stretch and strengthen the muscles of the thighs. For this, the doctor prescribes a course of physical therapy. During classes, the doctor shows all the exercises required for treatment, and the exercise therapy instructor controls their implementation. A set of exercises is needed to form and maintain the balance of the thigh muscles. A visible result is usually observed after 4-6 weeks.

After the operation, the wound is covered with a clean bandage. Initial exercises are necessary to control swelling and pain. After removal of postoperative edema, a set of exercises is performed to strengthen the muscles. Classes are usually held within 1.5-2 months after surgical treatment. This set of exercises is necessary to eliminate problems with the trochanteric bag in the future.

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The concept of bursitis

Bursitis is an inflammatory disease that affects the synovial periarticular bursa, or bursa. Synovial bags are adjacent to the bone joints - shoulder, elbow, knee, hip - and act as shock absorbers, smoothing friction when the muscles slide against the bone. Synovial bags contain fluid, which under the influence of certain factors can become inflamed.

The femur is characterized by a bony protrusion called the greater trochanter. Muscles that ensure the functioning of the hip joint are attached to this formation. A synovial bag adjoins the trochanter, in which irritation and inflammation can occur, leading to the development of hip bursitis.

Other synovial bags adjoin the hip joint, but most often inflammation occurs in three of them:

spit bag;
ileo-comb bag;
seat bag.

Types of bursitis

The inflammatory process that occurs in the trochanteric bag causes a pathology of the same name - trochanteric bursitis (trochanteritis). This type of synovial bag is located near the greater trochanter of the thigh. With inflammation, pain occurs in the region of the greater trochanter - a bony protrusion on the femur (external). Next to this bag is the subtrochanteric synovial bag, the inflammation of which proceeds identically to the inflammation of the trochanteric bursa and is eliminated by the same methods.

The iliac crest bursa is located in front of the lumboiliac muscle. Pathology in this synovial bursa leads to iliopectineal bursitis. Since this bag is connected to the joint cavity, inflammation in it resembles coxitis (an inflammatory process of the hip joint). Pain occurs in the anterointernal surface of the thigh (just below the groin). When the hip joint is extended, pain increases, swelling or swelling may occur.

The ischial bag is localized at the point of attachment of the muscles to the ischial tuberosity. Inflammation in it leads to ischial bursitis, which is characterized by pain when bending the hip.

Symptoms of hip bursitis

The main manifestation of bursitis is pain in the hip joint, which spreads mainly along the outer surface of the thigh. The early stages of the pathology are characterized by acute and intense pain. With the further development of the disease, the pain becomes less obvious.

Pathology takes a chronic form. At the same time, swelling occurs in the area of localization of the inflammatory process, which acquires a rounded shape and is characterized by a soft texture. The chronic form of bursitis does not cause dysfunction of the affected joint. Patients note the absence of burning pain.

In the acute stage of the pathology, the amount of fluid in the cavity of the affected bursa increases - cysts filled with exudate are formed - special symptoms of hip bursitis.

If the inflammatory process in the synovial bag occurs under the influence of infection, purulent bursitis develops, in which there is a sharp pain, especially when the limb is abducted and the hip is extended and flexed. Edema is formed on the outer side of the thigh, the patient cannot fully bend or straighten the thigh.

In addition to pain, there are additional symptoms of hip bursitis:

swelling occurs at the site of the lesion, the size of which in diameter can reach up to 10 cm;
swelling around the inflamed bag;
heat;
deterioration in general condition.

Signs of bursitis in animals

Trochanteritis is a disease that occurs not only in humans, but also in domestic animals. Often, dog owners are faced with such a pathology of their pets as hygroma - this is a swelling that forms on the surface of the olecranon, in the area of the calcaneus, and also at the location of the greater trochanter of the thigh. If a thick fibrous capsule has formed on the paw, the cavity of which is filled with liquid, we can say that there is a hygroma (bursitis) of the hip joint. Symptoms in dogs include:

the affected area of the limb (paw) is hot;
the animal holds the limb on weight;
the dog's body temperature exceeds the norm, sometimes reaching 39.5 degrees;
mobile swellings form under the skin, which can spontaneously open, and pus flows out of them.

Pathology often occurs either in very young or in old animals. Large breed dogs are also more susceptible to the disease.

Bursitis can occur due to:

infectious agents;
incorrectly chosen bedding for the animal;
uneven physical activity;
hypothermia.

Human Risk Factors

Bursitis of the hip joint occurs more often in women than in men. Basically, pathology is diagnosed in the fair sex of middle or old age. Young men are rarely diagnosed with hip bursitis. The causes and treatment required to eliminate the manifestations of the disease can be very individual. Everything will depend on the body of a particular person. However, there are common factors, the impact of which leads to the development of pathology.

Bursitis of the hip joint is formed against the background of:

Injuries of the femur - a fall on the thigh, a blow to something, a long stay of a person on one side of the body in a horizontal position.
Periodic excessive stress on the hip joint - when climbing stairs, running long distances, cycling, standing for a long time.
Pathology can occur with a physiological deficiency - different leg lengths, which have a direct impact on a person's gait. In this case, the synovial bags of the hip joint are subject to severe irritation.
Bursitis can be the result of concomitant diseases, such as rheumatoid arthritis, spinal pathologies (scoliosis), and so on.
Surgical intervention in the area of the hip joint, as well as arthroplasty, can become a trigger in the development of pathology.
The presence in the body of deposits of calcium salts in the area of the tendons of the greater trochanter leads to irritation and inflammation of the synovial bag and, as a result, to bursitis.
Hypothermia, physical inactivity (a sedentary lifestyle), overweight are companions of bursitis.

I must say that sometimes pathology occurs without any external causes.

Diagnostics. Inspection

In the diagnosis of hip bursitis, a set of methods is used. The specialist conducts a conversation with the patient, as a result of which he finds out the presence / absence of concomitant diseases, possible previous surgical interventions. Particular attention is paid to a thorough examination of the patient, taking into account all his observations. The specialist takes into account complaints of increased soreness and sensitivity in the area of the protruding areas of the thigh.

Of all types of bursitis, trochanteric bursitis is the most common. This form of pathology is characterized by burning pain in the area of the hip joint. The pain may radiate along the outer surface of the thigh. It is difficult for the patient to be on one side for a long time during rest or sleep. The pain syndrome intensifies with active movement - when walking, squatting, sharp rotation of the hip, climbing stairs.

If there was a bruise of the hip and the pain is severe, acute bursitis is suspected. Often, the development of pathology as a result of an injury is preceded by a strong click, which is noticed by patients. Sometimes medical workers are interested in the type of activity of the patient, because the described disease is common among athletes.

Other examination methods

Since the hip joint is surrounded by a layer of muscle tissue, palpation of the thigh area is performed at the first stage of examination and diagnosis. With this manipulation, the area in which pain is felt is revealed. Next, the position of the joint is determined, in which the pain syndrome acquires the greatest amplitude (the doctor moves the patient's leg from side to side).

Often the diagnosis is clear at the stage of examination, and additional diagnostics are not required, however, the patient may be assigned additional methods of research in cases that are ambiguous and controversial, or to exclude possible injuries and other pathological manifestations.

For example, an x-ray with trochanteric bursitis reveals calcifications in the soft tissues in the region of the greater trochanter. Magnetic resonance imaging clearly shows the inflammatory process of the trochanteric bursa and the accumulation of fluid in it. Performing an ultrasound examination also helps to determine the accumulation of excess fluid in the bag.

Bursitis treatment

The methods used in the treatment of bursitis depend on the period of the course of the disease. So, in the initial stage of the disease, for the successful recovery of the patient, he is required to perform physiotherapy exercises, use anti-inflammatory drugs and adhere to the daily regimen, the main component of which is the complete rest of the patient and minimizing strong physical exertion and activity. To eliminate the symptoms of hip bursitis, drug treatment begins with the use of anti-inflammatory nonsteroidal drugs. It can be both oral preparations and ointments, gels, for example, Diclofenac. Often in therapy, a 2% solution of novocaine is used together with hydrocortisone (glucocorticoid hormones) to relieve severe pain. The patient is advised to avoid movements that cause pain. After the pain syndrome is stopped, you can perform light physical exercises aimed at training and strengthening the gluteal muscle.

In advanced cases (if the above methods do not have the desired therapeutic effect), they resort to physiotherapeutic procedures - laser therapy, magnetotherapy, electroanalgesia, decimeter wave therapy, naftalan applications. Sometimes shock wave extracorporeal treatment is effective in the treatment of bursitis.

The failure of these procedures will entail the injection of drugs containing glucocorticoids (in the area of the greatest pain), and sometimes surgery. The principle of surgery for trochanteric bursitis is to relieve tension in the ilio-tibial tract. Sometimes excision of the trochanteric bag of the joint is performed. The prognosis for recovery in such operations is overwhelmingly good.

Complications and rehabilitation

The main complication of trochanteric bursitis is the transition of the disease from the acute stage to the chronic stage. When the disease is chronic, in most cases, surgical intervention is necessary - an operation.

As a rule, the symptoms of hip bursitis disappear after a maximum of a few weeks. However, there are cases when the symptoms of the disease do not go away for several months, in which case we can say that the pathology has passed into the chronic stage. At the same time, the pain syndrome and limitation of the internal mobility of the thigh persist.

In the case when adhesive capsulitis is formed - inflammation of the capsule of the hip joint, the patient has a feeling of a "frozen" hip joint.

The left side of the picture illustrates an inflamed joint. In this case, there is a partial or complete violation of its mobility. The right side of the picture reflects the healthy state of the capsule.

If surgery has taken place, it is very important to undergo the necessary rehabilitation. During this period, it is recommended to use aids when moving - crutches, canes, walkers. This is especially true for the first days after the operation. However, it is necessary to start moving and get out of bed on the day of the manipulation itself. This contributes to the correct restoration of tissues. A few days after the operation, the pain syndrome that accompanies hip bursitis usually disappears.

Treatment with folk remedies

Treatment of bursitis with the help of traditional medicine recipes is aimed primarily at stopping the inflammatory process. In most cases, absorbable compresses are used for these purposes.

For example, with bursitis of the hip joint, rub 1 tbsp. a spoonful of laundry soap, add a spoonful of honey, grated onion (1 tablespoon). The resulting mass is thoroughly mixed and laid on a cotton cloth. The compress is applied to the inflamed area, wrapped with a woolen cloth, kept for 2-4 hours. Treatment is usually carried out within seven days.

There is another effective compress recipe that helps eliminate the manifestation of the disease (hip bursitis), symptoms. Medicines are made on the basis of two glasses of alcohol mixed with a bottle of pharmacy bile, two glasses of horse chestnut and aloe. The resulting mixture is kept for a week and a half. Then a linen cloth soaked in the product is applied to the sore spot. Keep the compress should be from 3 to 4 hours. Treatment is carried out for ten days.

In order to get rid of bursitis, use a burdock leaf, a cabbage leaf. These herbal remedies have an antitumor (retardant) effect. Often, traditional medicine suggests using vegetable compresses from beets, potatoes, cabbage. The vegetable is rubbed on a fine grater and spread on a natural fabric with a layer of about 0.5-1 cm. The therapeutic compress should cover the area of edema (swollen area) completely. Treatment is carried out from 2 to 4 hours, during the week.

Summarizing all of the above, we can conclude that bursitis is a disease, the occurrence of which is due to a number of factors, namely: excessive physical activity, previous surgical procedures, infectious pathogens. Pathology is treatable, but it is important not to start the disease, and when the first manifestations of the disease appear, contact a specialist and start therapeutic procedures.

The article describes in detail what hip bursitis is. Symptoms, photos illustrating the manifestation of the disease, methods of treatment are also covered in the materials of this topic.

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Features of the disease

Trochanteric bursitis of the hip joint often complicates the course of osteoarthritis. Most often affects women after forty years. The elderly (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 region of the greater trochanter. If it is not removed, it will disturb during physical activity, during the rest period. This greatly impairs the patient's quality of life.

Risk factors for trochanteric bursitis

Diseases are more predisposed to women in middle, advanced age. Predisposing factors of the disease:

Hip injury. Often occurs when falling on a joint. As a result of hitting a corner, with a long stay in a standing position, the mucous bag of the greater trochanter is irritated, which contributes to inflammation.
Intense sports activities.
Endoprosthesis operation. The disease is caused by a postoperative scar. It stretches soft tissues, irritation of the trochanteric bag 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 bursal friction is exacerbated because the joint does not produce enough intra-articular fluid. The joint degrades, its cartilaginous tissue changes.

Symptoms of trochanteric bursitis

The main symptom of bursitis is pain. It spreads along the outer surface of the femur. It is sometimes very stinging. The patient cannot lie on the injured side. The pain is exacerbated at night, the patient is disturbed by a healthy normal sleep. Pain symptoms intensify when climbing stairs, rotating the hip.

A swelling is palpated in the region of the trochanter of the femoral bursa. When pressed on it, the pain intensifies. The rotation of the joint is not disturbed. Trochanteric bursitis is characterized by the fact that in a supine position on a sore leg, the pain intensifies. This deprives a person of proper sleep. Soreness is able to radiate down, being localized on the lateral surface of the joint.

Characterized by the appearance of pain when walking with irritation of the articular bag. In the first minutes of walking, the pain is stronger, then it subsides. If you cross your legs in a sitting position, the pain intensifies. Perhaps the appearance of vegetative-vascular disorders.

External examination with trochanteric bursitis of the hip joint shows the invariance of the contours. It is explained by the fact that the trochanteric bag 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 disturbed by an attack of severe, rapidly growing pain. Localization - in the region of the greater trochanter of the joint. Active movements in the joint are painful, markedly limited. When the hip is abducted, the symptoms increase. Passive movements in the hip joint are painless, free, do not cause inconvenience.

On palpation of the articular bag, a painful, dense formation is found in the region of the greater trochanter. It leads to an additional restriction of active movements. The patient's body temperature is often subfebrile. The inflammatory process in the body leads to an increase in the erythrocyte sedimentation rate.

Acute phenomena with trochanteric bursitis subside in a few days, rarely weeks. In some patients, trochanteric bursitis acquires 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 the appearance is the improper treatment of acute bursitis, a late visit to the doctor.

Features of the chronic form of the disease are less pronounced symptoms of the disease. The pain is not strong or absent. On the radiograph, ultrasound shows areas of change in the region 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 bag affects the health of the diseased joint.

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

Features of trochanteric bursitis

Trochanteric bursitis has characteristic features:

The pain is strong, deep, sometimes burning, located on the lateral surface of the joint. Sometimes it looks like a box.
Pain occurs while walking on a flat surface, increases while climbing stairs, squatting, moving legs to the side.
Pain relief occurs at rest.
At night, increased pain is characteristic, especially if a person lies on the side affected by inflammation.
Palpation of the joint increases the pain.
The pain syndrome is intermittent.

Diagnosis of trochanteric bursitis

The diagnosis is based on instrumental methods:

X-ray study. Able to detect a change in the bone, joint in the region of the greater trochanter.
Scintigraphy. Changes in the upper lateral region, greater trochanter indicate bursitis or tendovaginitis.
Magnetic resonance imaging is the last word in the diagnosis of disorders of the hip joint. MRI allows diagnosing pathologies of soft tissues, changes in muscles, bones, 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 allows you to prescribe an accurate, effective treatment of the joint.

Diagnostic methods allow you to solve the problem of treating bursitis.

Features of the treatment of the disease

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

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

Physiotherapy is an important link in the treatment of trochanteric bursitis of the hip joint. Usually applied, depending on the occasion, heat, cold, UHF. Reduces swelling, inflammation in bursitis, promotes a speedy recovery.

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

In the presence of inflammatory fluid in the mucous bag of the joint, its extraction is indicated. This is done with a puncture. It is harmless to the joint. The extracted fluid is used for laboratory testing for diagnostic purposes. Intra-articular injections are indicated. The injections include anti-inflammatory, analgesic drugs. The effect is long lasting. After injections, patients are advised to sleep on a pillow under the buttocks. In rare cases, the injection is repeated.

Treatment for exacerbation of the disease

With an exacerbation of the disease, therapeutic 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 with the use of hydrocortisone;
Applications with naftalan;
shock wave therapy;
Local cryotherapy with dry air.

What you need to know about surgery

Surgical treatment is used if conservative treatment fails. During the operation, the doctor makes an incision in the sac. She is removed, the large skewer is examined. Irregularities on it are removed, the surface is smoothed. The skin is sutured. The wound is covered with a sterile dressing.

Rehabilitation measures are aimed at the speedy restoration of the working capacity 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 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 enhancing physical exercise, fighting bad habits, and diet. It is important that the person is not in a standing position for a long time. The elderly are shown physiotherapy procedures, relaxation at the resort.

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Causes of hip bursitis

Disease leads to:

Injuries to the femur from falling and hitting sharp corners.
Long-term dynamic and static loads:
- a ride on the bicycle;
- climbing a mountain or stairs;
- running, especially on inward or outward inclined roads;
- lying on one side, etc.
Deforming, degenerative and inflammatory diseases of both the lumbosacral region and the spine as a whole.
Asymmetry in the length of the lower extremities: even a two-centimeter difference in length causes limping and tension in the hip joint.
Previous operations in the hip joint: osteotomy, insertion of metal structures and wires, arthroplasty.
Rheumatoid, infectious, allergic arthritis.
Bechterew's disease.
Congenital hip dysplasia.
Ossification of the tendons (deposition of calcium salts) and the formation of osteophytes.

There are many tendon bags in the hip joint.

Types of hip bursitis

Basically, hip bursitis develops in three bags:

Spitting:
- at the point of attachment of the gluteus medius, piriformis, upper and lower twin muscles to the greater trochanter.
Iliac-comb:
- in the inner inguinal region of the thigh, where the tendons of the iliopsoas and pectineus muscles are located.
Ischial:
- in the area of attachment of the tendons of the muscles of the back of the thigh (biceps, semitendinosus and semimembranosus) to the ischial tuberosity.

Bursitis of the hip joint should be distinguished from synovitis - inflammation of the synovial membrane surrounding the joint itself - the articulation of the femoral head with the acetabulum.

Symptoms of hip bursitis

Trochanteric bursitis (trochanteritis)

Trochanteric bursitis occurs most frequently, and mainly in female athletes, due to the anatomically wider pelvis, which increases the friction of the tendons in the area of attachment.

The disease is promoted by long-distance running.

Main symptoms:

Sharp, burning pain, radiating along the outer surface of the thigh, aggravated by rotational movements inward (pronation), squatting, climbing stairs.
It becomes impossible to lie on the affected side.
With bursitis of a traumatic nature, the pain is sudden and sharp, traumatic damage may be accompanied by a click.
For other reasons (scoliosis, arthritis, etc.), pain symptoms increase gradually, day by day.

Iliococcipital bursitis

Due to the connection of this bag with the articular cavity, iliopectineal bursitis resembles hip synovitis in its symptoms, which is the main symptom of coxitis (hip arthritis).

Symptoms:

Pain in the thigh, along the anterior inner surface, below the ligaments of the groin.
When the hip is extended, pain increases, for example, at the time of getting up from a chair or lifting the hip.

ischial bursitis

Symptoms:

Pain at the time of hip flexion: when sitting down on a chair or squatting.
Pain also occurs if you sit or lie down for a long time.
The ischial tubercle on the affected side is enlarged.
The pain gets worse at night.

Diagnosis of trochanteric bursitis of hip joint

The main diagnostic value is an examination by an orthopedist:

So, trochanteric bursitis manifests itself as pain during palpation of the greater trochanter.
With tendinitis of the gluteal muscles, similar pains also occur, but they accompany hip abduction. Pain in trochanteric bursitis occurs during adduction and pronation of the femur.
To differentiate the disease, the doctor lays the patient on a healthy side and performs abduction, adduction and rotation of the diseased hip.

One of the tests is Auber's test:

The upper leg is bent at a right angle and taken to the side.
Then the legs are extended in the TBS.
Release the leg and observe its adduction.

If adduction does not occur to the end, this indicates tension in the wide fascia of the thigh and its continuation - the ilio-tibial tract (IBT), which starts from the ilium and ends at the condyle of the tibia. PBT tension is a sure symptom of trochanteric bursitis.

Instrument diagnostics is also used:

radiography, magnetic resonance or computed tomography.

On x-rays, areas of tendon ossification near the greater trochanter and osteophytes in the places of their attachment are sometimes clearly visible.

Treatment of hip bursitis

Non-steroidal drugs are prescribed:
- ibuprofen, piroxicam, naproxen, celecoxib.
With severe severe pain, you can resort to crutches or canes.
When acute pain is stopped, they begin physiotherapy exercises, which include exercises:
- for stretching (scratching) of the fascia lata and tensor of the fascia lata, iliac-tibial tract and biceps femoris;
- to strengthen the muscles of the buttocks.

Physiotherapy treatment

In the physiotherapy of hip bursitis, mainly extracorporeal shock wave therapy is used.

Treatment with a magnetic field, laser therapy, electrophoresis, applications and other methods is most often useless, or plays the role of a placebo.

Since physiotherapy is carried out mainly during the recovery period, it often coincides with remission, in which the pain subsides on its own for a period.

Surgery

Surgical treatment for hip bursitis is used very rarely: the basis for surgical intervention here are much more serious reasons:

hip fractures, dysplasia, deforming arthrosis.

With bursitis, both arthroscopy and wide access operations are practiced.

During arthroscopy, the affected bursa is removed using two small incisions: an arthroscope with a microscopic camera is placed in one, and a surgical instrument is inserted into the other.

The main point of most operations is to loosen the PBT tension:

A longitudinal incision is made in the region of the greater trochanter, exposing the iliotibial tract, the tensor fascia lata, and the gluteus maximus muscle.
Then, through the incision in the PBT, they penetrate to the trochanteric bag located under it.
The bag is excised, and an oval-shaped flap is cut out from PBT above the lateral epicondyle of the femur, or a Z-shaped plastic is performed to facilitate tension.

Complications and prognosis

The prognosis for bursitis is favorable, if you do not start the disease and prevent it from moving into the chronic stage.

Of the possible complications:

chronic PBT tension syndrome;
limited mobility, especially internal rotation;
"frozen" hip - with involvement of the joint capsule (adhesive capsulitis).

The symptoms and treatment of hip bursitis are related. Without knowing the symptoms, it is impossible to make a diagnosis and prescribe adequate therapy. And without timely medical care, the risk of developing complications such as fistulas, sepsis, calcification and tissue necrosis increases.

Etiology of the disease

Trochanteric bursitis of the hip joint belongs to the group of inflammatory diseases, characterized by damage to the synovial bursa (bursa). Its purpose is to provide "sliding" of the hip joint during movement due to the release of synovial fluid.

The main causes of the disease:

Excessive physical activity on the hip joint (running, cycling, professions with prolonged static loads on the limbs);
Hip dysplasia:
Osteochondrosis;
Gout;
arthrosis and arthritis;
Chronic foci of infection;
Injuries of the hip joint;
Asymmetry of the lower extremities;
Diabetes, obesity.

Predisposing factors for the development of the disease are endoprosthesis surgeries, advanced age, the formation of osteophytes in the hip joint, and hypothermia.

Types of bursitis

According to the international classification of ICD 10, the disease was assigned a code:

M71.1 are other infectious bursitis;
M71.5 Other bursitis not classified elsewhere.

For diagnosis and preparation of a treatment regimen, bursitis of the greater trochanter of the femur is divided into types according to the focus of pathology:

Trochanteric - the bursa is located in the zone of attachment of the gluteus medius and piriformis muscles to the greater trochanter. It is more often diagnosed in the elderly and athletes;
Ischio-gluteal bursitis - the bag is located at the point of attachment of the tendons and gluteal muscles to the ischial tuberosity;
Iliac-comb. The localization of the focus is the inner side of the inguinal region, where the tendons of the iliopsoas and pectineus muscles are located.

Of particular danger is purulent bursitis. The bag is filled with pus, the infection spreads to nearby tissues and bones. If left untreated, the risk of death or sepsis is high.

Symptoms

Early signs of hip bursitis are acute discomfort at the site of inflammation. If the liquid in the bag is infected, then there is pain that manifests itself when moving, in advanced stages, the pain syndrome torments even at rest, especially at night.

General symptoms of the disease:

Hyperthermia;
Swelling of the affected limb, thigh muscle tension;
Lameness, "duck gait" in severe disease or complications.
Limited mobility of the hip joint.

When trying to palpate and examine, pain is noted, it is difficult for the patient to find a comfortable position, there is nervousness. Bursitis of the greater trochanter of the thigh is clinically manifested by the following symptoms:

Pain of a sharp, burning character;
It radiates along the outer side of the thigh, increases when performing rotational movements of the limb, climbing stairs, bending the limbs in the hip and knee joints;
Inability to lie on the side of the affected limb;
When a limb is injured, the pain is sudden, the hip joint makes clicks when moving;
Periodic numbness of the limbs;
With scoliosis, arthritis, the pain syndrome increases gradually.

Among women, athletes with a wide pelvis are more likely to suffer. Due to anatomical features, the friction force of tendons and muscles increases, which provokes early wear of the bones of the musculoskeletal system.

The symptoms of iliac scallop bursitis are similar to the clinical picture of arthritis, the recurrence of which occurs after hypothermia or excessive physical exertion. Distinctive features of this type of bursitis:

Pain on the inside of the thigh;
Increased pain when extending the hip joint (rising from a chair).

Ischio-buttock bursitis is characterized by the appearance of pain syndrome when the body is in one position for a long time, the predominance of night attacks, the swelling of the ischial tuberosity is visually diagnosed in the photo. According to scientists, the reason for the involvement of the sciatic nerve in the inflammatory process is a decrease in the production of synovial fluid during the transition of the disease to the chronic stage.

Interesting!
Pathology in the chronic form is characterized by an erased clinical picture, with exacerbation, there is pain when walking and swelling in the focus of inflammation.

Diagnostics

To resolve the issue of what hip bursitis is and how to treat it, it is necessary to confirm the diagnosis with the help of an orthopedist.

To diagnose the disease, a visual examination of the limb is performed, followed by palpation, during which the following symptoms are recorded:

Soreness of the greater trochanter when bringing the limb to the body;
With bursitis of the iliopsoas muscle, hip abduction is painful;
Ober test: the patient is placed on a healthy side, the diseased leg is bent 90 degrees and taken to the side, after which it is unbent at the hip joint, lowered and an attempt is made to bring it to the body. If it is impossible to perform the last action, the symptom of trochanteric bursitis is confirmed.

X-ray, MRI or CT are used as instrumental diagnostics. On the x-ray image, osteophytes and areas of ossification (ossification of tissues, muscles and ligaments due to injury) are distinguished.

Medical treatment

The purpose of the therapy is to relieve pain and signs of inflammation, and prevent the development of complications.

Drug treatment consists in the appointment of the following groups of drugs:

Non-steroidal anti-inflammatory drugs - Celecoxib, Ibuprofen or Piroxicam;
For the relief of pain - Diclofenac (prescribed on a tablet with an interval of at least 4-5 hours until the pain disappears completely) or Analgin;
Corticosteroids - Prednisolone (a hormonal agent, taken at 20-30 mg / day).

To prevent the transition of the disease into a chronic form, apply:

Dihydroquercetin plus - a natural antioxidant, improves tissue microcirculation, is taken 4 tablets 2 times a day. As part of vitamin E and C, dihydroquercetin, the drug is a biologically active substance;
Osteo-Vit is a chondroprotector, activates regenerative processes in cartilage tissue, and normalizes mineral metabolism. As part of vitamin D and B6, drone homogenate;
Elton P is a biologically active complex aimed at providing the body with the necessary microelements, vitamins C, E. A remedy is prescribed during the rehabilitation period to maintain the body's work.

exercise therapy exercises

With the successful treatment of hip bursitis with drugs, physiotherapy exercises are additionally performed:

Lying on your back, bend your legs at the knee joints, spread your knees to the sides and return to the starting position. It is necessary to exclude pain during the exercise. Repeat 10-15 times;
Sitting on a chair, reach your heels with your fingers, return to the starting position. Repeat 10-20 times;
Leaning on the wall, swing with a free limb with a small amplitude 10-15 times. Change position, repeat the exercise with the other leg.

The purpose of gymnastics is to restore the motor function of the musculoskeletal system and strengthen the muscular system.

Surgical treatment and physiotherapy

Surgical intervention for bursitis consists of arthroscopy or wide access surgery. Arthroscopy is a surgical operation that consists in removing the inflamed bag with an arthroscope through two incisions.

If it is impossible to carry out sparing surgical treatment, the region of the greater trochanter is dissected and the affected bursa is excised, Z-shaped plastic is performed to relieve the tension of muscles and tendons.

In the process of rehabilitation and in order to prevent the recurrence of the disease, physiotherapeutic procedures are carried out:

Laser therapy;
mud applications;
Electrophoresis.

Treatment of recurrent bursitis with physiotherapy is ineffective compared to drug therapy.

Folk methods

At home, in the initial stages of the disease, alternative methods of therapy are available that do not require special skills. The main recipes for reducing pain, swelling, inflammation in the hip joint:

In equal quantities, prepare honey and shavings of laundry soap, melt the components in a water bath, apply the mixture to the prepared gauze, and distribute the pre-chopped onion on top. Place the finished compress on the area of inflammation, wrap with polyethylene and a scarf. Course duration - 14 days;
Pour 250g of dry or fresh horsetail grass with vodka and insist for 7 days. Use the finished product as compresses at night for 10 days;
In 1 glass of water, add 1 tbsp. crushed joints of the golden mustache, boil the mixture for 5 minutes. and insist 60 min. Dip gauze in a warm broth, wrap around the joint, secure with polyethylene and a scarf, leave overnight. The course of treatment is 20 procedures.

With timely treatment of hip bursitis, the prognosis is favorable. If the process becomes chronic, then regular monitoring of the condition, limitation of physical activity, gymnastics and massage are necessary.