Where is the greater trochanter of the thigh located? Pain in the hip joint - treatment

Nature created so that the muscles that provide motor activity in the hip joints lengthen and contract. 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 bags, for example, trochanteric bursitis of the hip joint.

In the practice of specialists, such a pathology is common, since this joint has a significant load in the life of every person. A pronounced pain symptom and a significant limitation of motor activity make it necessary to seek medical help.

Inflammation of the trochanteric bursa

Causes

Pathology is especially widespread among athletes, for example, sprinters-runners. When training becomes more difficult, the friction of soft tissues increases, which creates a predisposition to injury.

Risk factors are:

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

Excess weight

Analysis of the activities of traumatologists reveals the following common causes of hip bursitis:

various injuries - serious bruises resulting from a fall or impact from the outside, 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 longer, which leads to a significant distortion, with further irritation and inflammation in the area of the articular bag;
acquired pathologies - various arthritis, gouty lesions, arthrosis;
physical overload associated with work activity or the chosen lifestyle;
bursitis of the hip joint is a constant companion of athletes, runners, sports cyclists;
a sharp and significant increase in the previously habitual load on the joints, for example, the need to move to the top floor in a house that is not equipped with an elevator, gaining more than 10-15 kg during pregnancy.

hard fall

The patient often during the consultation can himself indicate the root cause that provoked the appearance of unpleasant manifestations of bursitis in him. 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 impossibility of being in a side lying position. This causes him a significant increase in pain impulses in the affected thigh. Moving up the stairs, long walking also seems difficult.

Unpleasant sensations can slowly increase or form suddenly. In the latter case, it is possible to link them with trauma. Some patients indicate that at this moment they clearly distinguished a kind of 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 expands - it can cover the entire thigh. At rest, the discomfort decreases somewhat, but increases during the hours of night rest - it is difficult for the patient to turn over to the side of the inflammatory focus.

Pain in the hip area

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

Diagnostics

In addition to a thorough history taking and a physical examination, other diagnostic measures are also recommended by a specialist to confirm a preliminary diagnosis:

radiography of the hip joint area allows to exclude a fracture of bone structures, to identify the presence of calcifications in the periarticular soft tissues or osteophytes;
modern methods include CT, MRI - signs of an inflammatory lesion of the trochanteric bursa, the accumulation of pathological exudate in it are revealed;
it is possible to conduct ultrasound - for a thorough examination of the soft and dense articular structures, not only in a static position, but also when moving in them.

ultrasound diagnostics

Only the fullness of the information obtained after the above diagnostic procedures allows the specialist to conduct an adequate differential diagnosis and make a complete diagnosis.

Treatment

Pathology requires an integrated approach to the appointment of therapeutic measures. In addition to creating functional rest for the hip joint and the use of anti-inflammatory drugs, the 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 of the affected joint - correction of physical activity, the use of assistive devices when moving;
taking anti-inflammatory drugs and modern analgesics recommended by a specialist, in the absence of an effect from oral use, perhaps their intra-articular administration;
as the inflammatory manifestations stop, various methods of physiotherapy are prescribed - ultrasound, electrophoresis, heating;
in order to optimally improve the 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 functional capabilities of the person.

Anti-inflammatory drug Celebrex

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

Its essence lies in the weakening of the tension of the iliac-tibial structures, with the possible excision of the articular bag. The prognosis is usually favorable.

ethnoscience

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

Pour 20 g of carefully crushed golden mustache shoots 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. The duration of the course is 20–25 days.
Heat a handful of flax seeds over moderate heat, wrap in linen cloth and apply to the thigh over the focus of pain impulses. After cooling, cover with a warm scarf. Recommended to do before bed. The course is at least 10-14 days.
Cut the leaves from a five-year-old Kalanchoe plant, place in the freezer for 1-2 days. Then take it out and beat it carefully. 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 also recommend taking anti-inflammatory decoctions - St. John's wort, chamomile, yarrow, burdock rhizome, celery seeds bring relief.

Wherever bones, tendons, or ligaments move and rub against each other, especially at the joints, the points of contact are cushioned by small fluid-filled sacs called bursa. 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 such joints as the shoulder, elbow, knee, femur, ankle. Inflammation and swelling of the bursa is called bursitis.

Causes of bursitis

Excessive load on the joint or injury, as well as prolonged load, can cause inflammation of the periarticular bag. The bag fills with excess fluid, which causes pressure on the surrounding tissues. The immediate first signal of bursitis is pain, often accompanied by redness, swelling, and soreness. 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 largest range of motion among all joints, is most often prone to bursitis at an older age. As a rule, shoulder bursitis pain occurs after sleep and regresses gradually during the day (pain is usually localized in the upper part of the shoulder). Other areas where bursitis is most common are the area of the elbow joints of the femoral knee and the area of the thumb.

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

Injury

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

It often develops due to the characteristics of a person's work. Heavy physical work associated with the need to perform long repetitive and heavy loads. The most common cause of chronic bursitis is a minor injury that can occur, for example, in the shoulder when a ball is thrown sharply. Or, for example, prepatellar bursitis occurs from prolonged kneeling while mopping.

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

Bags are 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 aureus. People with a weakened immune system (diabetics, 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 bags is possible. In addition, diseases such as gout or pseudogout due to the deposition of salts in the bag can cause the development of bursitis.

Symptoms

Common symptoms of bursitis include:

Pain, inflammation, and swelling in the shoulder, elbow, hip, or knee, especially when the joints are extended.
Stiffness or decreased range of motion in a joint with or without pain.
Weakness in muscles due to pain. may cause pain and tenderness in the affected bone or tendon. Bags can grow in size, which can cause difficulty in movement. As a rule, bursitis occurs in the area of the shoulder, elbow, knee and thigh.

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 trauma 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 sides of the shoulder. Discomfort causes the institution of the arm above the head and the load on the shoulder.

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

Elbow

Elbow tip bursitis (olecranon) is the most common form of bursitis.

The pain may increase in the flexed elbow as the pressure on the bursa increases.
This type of bursitis is most often post-traumatic in nature and can be associated both with direct trauma and with excessive rotation and flexion at the elbow (for example, when painting).
Infection is also quite common in this type of bursitis.

Knee

Prepatellar bursitis anterior patella. A swelling on the anterior part of the patella can be caused by chronic trauma (like 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 of the location of the three main tendons of the inner part of the knee. This type of bursitis occurs most often in patients with arthritis and is usually middle-aged women with overweight. Popliteal bursitis is manifested by 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 to the inner thigh. Popliteal bursitis is also common in athletes, especially long-distance runners.

Ankle

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

Also, this bursitis can be a consequence of Achilles tendonitis.

Bursitis in this part of the body often occurs as a result of excessive exercise in young athletes, skaters, and adolescent females starting to wear high heels. Pain is usually localized at the end of the heel and increases with movement of the foot.

Buttocks

Bursitis ischiogluteal(Ischiogluteal) is caused by inflammation of the ischial bursa, which is located between the base of the pelvic bone and the large muscle of the buttocks (musculus gluteus maximus). Inflammation can 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.

Perhaps soreness in the pubic bone, which increases with flexion and stretching of the leg.
The pain may radiate down the back of the thigh.
When pressing in the area of the inflamed bag, acute pain appears.
The pain is aggravated by lying down with the hips passively flexed.
It may be difficult to stand on tiptoe on the affected side.

Hip

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

Pain in iliopsoas bursitis is localized in the anterior part of the thigh, radiating to the knee, and increases with hip extension and rotation. “Hip extension while walking causes pain so that you have to shorten your step and limit the load on the leg. Pain in the groin area is possible. Sometimes an enlarged bag can resemble a hernia. There may also be sensations such as tingling or numbness if there is compression of sensory nerves by an enlarged bag.

Acetabular bursitis(bursitis trochanteric) is located in the upper part of the femur occurs, as a rule, in overweight middle-aged women. Acetabular bursitis is manifested by pain in the side of the thigh with irradiation to the buttocks or knee. Pain is aggravated by movement of local pressure or stretching of the leg. The pain worsens at night and prevents sleep on the affected side. Considering that bursitis can be infectious in nature and will require antibiotic treatment or a puncture of the bag, it is necessary to seek medical help in the following cases.

The presence of pain in the joint for more than a few days.
Restriction of mobility in the charter.
The presence of puffiness that does not disappear after taking NSAIDs.
An increase in temperature in the presence of pain in the joint.
Warmer to the touch areas in the joint area or redness.
Areas of pain in the joint area.

Diagnostics

The diagnosis of bursitis is made on the basis of a combination of symptoms, clinical manifestations, medical history and instrumental diagnostic methods. The history of the disease allows you to find out the presence of concomitant somatic pathology.

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

Radiography can visualize the presence of osteophytes or arthritis.
Analysis of punctate (microscopy), which was obtained as a result of puncture of an enlarged bag, allows you to exclude gout and the presence of infection. Bursitis in the knee and elbow is the most common infection.
Blood tests can rule out rheumatological diseases (such as rheumatoid arthritis) and metabolic diseases (diabetes mellitus).
MRI may be prescribed if detailed visualization of the morphological picture is required.

Treatment

Although bursitis usually heals on its own and disappears after a few days or weeks, steps must be taken to reduce the burden or trauma. There are patients who prefer to endure pain manifestations, but this can lead to the development of chronic bursitis, the formation of calcium deposits in soft tissues, which will eventually lead to limited mobility in the joint.

The first step is usually drug treatment. NSAIDs help reduce pain and inflammation. It is also possible to use steroids in a short course (taking into account the presence of somatic diseases). In case of infected bursitis, a course of antibiotics is mandatory.

Puncture of the inflamed bursa allows excess fluid to be aspirated and relieves pressure on surrounding tissues. Injections of anesthetics along with steroids into the inflamed bursa help reduce the inflammation.

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

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

Prevention of bursitis is the exclusion of loads that led to the development of bursitis. Orthopedic appliances are often recommended, especially if the job involves a certain risk of traumatic movements. Exercise therapy also allows you to optimize the work of muscles and ligaments.

Performing their main function - contraction and relaxation, the muscles rub against the bones, tendons and each other. To muffle this friction in the body, there are special purpose synovial bags - bursae.

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

With the development of the disease, the pain is muffled and spreads to the entire body.

Bursitis of the hip joint must be treated in time

- an orthopedic disease in which the synovial periarticular bag becomes inflamed. The bag 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. a large trochanter to which the muscles of the hip joint are attached. The greater trochanter, in turn, is covered by a synovial sac.

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

Iliococcipital bursitis

On the inner side of the femur, there is the following synovial bag: iliac-scallop or iliac-lumbar. Pain with this type of bursitis is localized in the groin area when the hip is extended. Less common than trochanteric bursitis.

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

ischial bursitis

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

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 that provoke bursitis:

Strong regular loads on the hip joint - running, cycling, climbing stairs, long standing position;
sedentary lifestyle;
Diseases of the spine, incl. arthritis, scoliosis, lumbar spine;
Congenital anomalies - uneven length of the legs also provokes irritation of the synovial bags, if one leg is 3-4 or more cm longer than the other;
Rheumatoid arthritis;
Deposition of calcium salts, the so-called. "bone spurs". Spurs, or osteophytes, occur in the area of the tendons of the greater trochanter of the thigh;
Previous 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 sac.

An inflamed synovial bursa causes severe pain

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

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

Painful swelling of a rounded shape at the site of damage to the joint;
Swelling around the synovial bag;
Temperature increase, 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 covering it with muscles. For this reason, testing is based on the analysis of the pain syndrome and special x-ray studies.

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

With pressure - palpation, the specialist hands determines the position and place in which the pain reaches its maximum.

On examination, the doctor performs an Auber test

A positive Auber test (for leg abduction) may indicate tension in the ilio-tibial tract.
To avoid pathologies and injuries, a joint scan and MRI are prescribed. X-ray examination can show areas of ossification in soft tissues, and ultrasound can show the presence of excess fluid in the bursa.

Treatment

Medical treatment

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

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

Physiotherapy for bursitis brings a good effect

In case of non-started cases, therapy is carried out on an outpatient basis, because. the introduction of the above combinations of drugs is performed directly into the defective synovial bag. Of the methods of physiotherapy, electrophoresis and ultrasound bring a therapeutic effect.

Herbal compresses

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

In the case when the fundamental principle of bursitis was trauma, biologically active complexes are prescribed.

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

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 are progressing.

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

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

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

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

Bursitis Prevention Methods

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

And do not forget to give the body a good rest after standing work.
The main 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 a while:

Maintaining muscle tone;
moderate physical activity;
Weight control;
Active lifestyle;
Refusal to lift weights.

Given all of the above, with the question "How to treat hip bursitis?", it is time to safely 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 surgery will help in more severe cases with minimal trauma.

Bursitis is an inflammation in the mucous bag of the joint. It acts as a shock absorber during movements, reduces friction during movements in the joint. There is a protrusion in the femur - a large trochanter. Muscles are attached to it, without which active movements in the thigh are impossible. The bag covers the greater trochanter, its inflammation leads to restrictions in movements in the femoral joint, the appearance of sharp, unpleasant symptoms.

Trochanteric bursitis of the hip joint develops as a result of irritation of the articular bag, subsequent inflammation. Inflammation of the tendons of the middle, small gluteal muscles develops in the places of their attachment to the greater trochanter. At the same time, the nearby mucous bag (trochanteric) becomes inflamed. This inflammation is a common cause of hip pain.

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, contribute to the improvement of 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 shown. 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.

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

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

A bursa or joint bag is a sac filled with a gel-like liquid that acts as a shock absorber and reduces the friction of the joints against each other.

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

Causes of the disease

Near the hip joint there are several synovial bags, since this part of the skeleton is subjected to a large load. The causes of all hip bursitis are approximately the same:

strong and regular physical activity on the hip joint;
intensive sports training;
hypothermia;
a variety of diseases, congenital anomalies and pathologies (arthrosis, arthritis, salt deposition, different lengths of limbs);
obesity;
passive lifestyle;
previously performed operations on the hip joint, past injuries and injuries;
elderly age;
infectious lesion of the articular bag;
violation of metabolic processes.

The 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.

ischial bursitis

The ischial joint capsule is located in the place where the bone ischial tuberosity connects with the muscles. With inflammation of the sciatic bursa, a person has symptoms of severe pain in the upper thigh, which increase 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, and also when sitting on something hard for a long time.

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, trochanteric bursitis appears. 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.

Sleep becomes almost impossible. When climbing stairs, a burning pain occurs in the leg and hinders the movement of a person. 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.

Iliac-scallop

The iliopectineal bursa is located on the inside of the femoral 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 the inflammation is just beginning, there are strong pain sensations, the pain point is located above the inflamed bag. As the bursitis develops, the pain gradually changes from sharp to aching, while covering a larger area.
Lethargy and apathy due to constant pain, loss of working capacity.
Sleep disturbance.
It is impossible to fully bend and unbend the lower limb.
Discomfort when climbing stairs, after walking for a long time.
Suppuration when an infection enters the bursa.
Increase in body temperature.
Swelling. Appears as a result of trauma. At first, the tumor becomes visible, but gradually it becomes smaller and disappears.

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

Complications of the disease

Bursitis of the hip joint, if left untreated, can become chronic.

In this case, all the capsules of the hip joint become inflamed, which leads to a limitation of its mobility. To prevent complications after the operation, it is necessary to strengthen the immune system, solve the problem of excess weight, spend more time outdoors, walking and strengthening the lower limbs, and give up bad habits.

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

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

Diagnostics

The patient undergoes a series of examinations, according to 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 there is bursitis, then such movement will be extremely difficult and cause sharp 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 muscle coverage. Therefore, it is based on the analysis of patient complaints and X-ray examination. MRI is necessary to detect osteophytes in the periarticular sac and to exclude the development of arthritis.

Therapy

With inflammation of the synovial bag of the hip joint, the initial goal is to eliminate the pain syndrome. It is necessary to provide complete rest to the diseased joint, to minimize the load on it when moving.

Treatment is prescribed with painkillers and anti-inflammatory drugs.

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

To prevent the recurrence of the disease should be used: natural chondroprotectors that normalize the blood supply to the cartilage and articular tissue. Antioxidants that nourish the articular tissue, quickly restore blood microcirculation (for example, dihydroquercetin). Useful biologically active additives based on bee products.

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

Also, non-infectious bursitis can be treated with injections of cortisone into the area of the bursa, sometimes along with an anesthetic. This treatment is usually done after an aspiration procedure. In the presence of a large amount of exudate, it is pumped out of the cavity of the bag, and drugs are injected there.

After the removal of acute inflammation and pain, physiotherapy is prescribed.

Physiotherapy treatment

Ozokerite and paraffin applications.
Microwave therapy.
Massotherapy.
Inductotherapy.
Electrophoresis.
Dry heat.

Operation

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

In this case, excision of the articular bag is prescribed. Arthroscopy is actively used, during which a small incision is made in the thigh and an apparatus is inserted that allows the doctor to control the instruments to remove the bursa.

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

Prevention

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

constant, but moderate physical activity, training of the muscles of the lower extremities;
it is necessary to take daily walks, while using a cane or special walkers;
maximum reduction in the load on the hip joint, limitation of physical activity, which provokes inflammation of the synovial bag;
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 a good 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 the recurrence of the disease.