Trochanteric Bursitis & Gluteus Medius

Trochanteric Bursitis

 

Mechanism

 

Repetitive friction of iliotibial tract over GT

 

Aetiology

 

Overuse in athletes

Common post THR

 

May be associated with gluteus medius tears

 

Symptoms

 

Pain over upper lateral thigh with activity

- often related to hip flexion

 

Examination

 

Localised tenderness & swelling over & posterior to GT

 

Pain with resisted abduction

 

DDx

 

Tears in gluteus medius

Stress fractures

Iliopsoas tendonitis

Intra-articular hip pathology

Spinal pathology

Tumour

 

MRI

 

May demonstrate fluid in bursa

 

Non operative Management

 

HCLA injection

- virtually all respond to HCLA but may need several

- almost never need surgery

 

Operative Management

 

Bursectomy

 

Baker et al Arthroscopy 2007

- arthroscopic resection bursa in 30 patients

- successful in all but one who went on to have a successful open bursectomy

 

Bursectomy + ITB lengthening

 

Craig et al ANZ J Surg 2007

- open proximal Z lengthening ITB in 17 patients

- one poor result

- one patient had a secondary repair gluteus minimus with excellent result

 

Distal ITB lengthening

 

Pretell Int Orthop 2009

- distal lengthening in 13 patients average age 50

- 12/13 good results

- 1 post op seroma

 

Tears Gluteus Medius and Minimus

 

Aetiology

 

Sporting injuries

Falls

LLD

 

Diagnosis

 

MRI

 

Ultrasound

 

Non operative Management

 

Rest / physio

- stretching +++

- eccentric exercises

- correction of LLD with shoe lift

 

HCLA

 

ECSW

 

PRP

 

Operative Management

 

Technique

 

Repair of tears + bursectomy

- open or arthroscopic

 

Results

 

Voos et al Am J Sports Med 2009

- arthroscopic repair tendon tears in 10 patients

- all had complete resolution of symptoms

 

Lequesne Joint Bone Spine 2008

- open repair in 8 patients

- lateral tears of gluteus medius all seen on MRI

- 3 gluteus medius tears were not seen on MRI

- good results in 7/8 patients