Injectable Treatments for Trochanteric Bursitis

Trochanteric Bursitis is a painful pathological condition of the hip which can significantly affect a patient’s daily activities and quality of life. Trochanteric bursitis occurs when the bursa of the greater trochanter, a small cavity containing fluid that helps reduce friction between bones, becomes inflamed. Additionally, trochanteric bursitis can result from tendinopathy or degeneration of the gluteal tendons attached to the greater trochanter. In this article, we will examine the causes, symptoms, and the role of ultrasound in the treatment of Trochanteric bursitis.

What are the causes of Trochanteric Bursitis?

Trochanteric Bursitis is a condition often associated with overuse of the hip joint, injury, or underlying disease. Some of the most common causes of trochanteric bursitis include:

Repetitive movements: Activities such as running, climbing stairs, or standing for prolonged periods of time, can lead to irritation of the trochanteric bursa and gluteal tendons. Trochanteric Bursitis often affects runners, cyclists, as well as individuals whose professions involve prolonged standing.
Trauma: Hip trauma or injury resulting from a fall or direct impact on the hip, may possibly lead to inflammation in the area of the greater trochanter.
Bone spurs: Over time, the formation of bone spurs around the hip can irritate the bursa and tendons.
Rheumatological disease: Conditions like rheumatoid arthritis can affect not only the joints but also the bursae, leading to bursitis, including trochanteric bursitis. It is therefore important for patients with rheumatological diseases to be aware of the possibility of secondary problems such as trochanteric bursitis.
Surgical intervention: Trochanteric Bursitis may occur in patients who have undergone surgery in the hip area.

What are the symptoms of Trochanteric Bursitis?

Trochanteric Bursitis mainly manifests with pain on the outer side of the hip. Common symptoms include:

Localized pain: Pain is usually concentrated in the area of the greater trochanter, on the outer side of the hip, but may also radiate to other areas such as along the thigh or posterior to the buttocks.
Tenderness: The affected area may be tender to the touch.
Pain during activity: Pain worsens with activities involving hip movement, such as walking and climbing stairs.
Pain at rest: In some cases, pain may also occur at rest, affecting the patient's sleep quality.

Ultrasound Diagnosis of Trochanteric Bursitis

Hip Ultrasound can accurately diagnose Trochanteric Bursitis through visualization of the greater trochanter bursa as well as the surrounding structures. This allows a specialized Radiologist to assess the bursa for signs of inflammation, such as increased fluid presence or thickening of the bursa walls, and the gluteal tendons for signs of tendinopathy and degenerative changes.

Additionally, ultrasound provides the opportunity for dynamic testing, allowing the Radiologist to observe the tendons, muscles, and bursa during various hip movements. This can help identify any abnormalities or friction contributing to the symptoms and also help rule out other possible causes of hip pain.

Management of Trochanteric Bursitis: Ultrasound-Guided Therapies

When conservative methods such as rest, physical therapy, and taking anti-inflammatory medication do not provide sufficient results, a specialized Radiologist may perform a minimally invasive, Ultrasound-Guided Injectable Therapy to address Trochanteric Bursitis.

Corticosteroid injection into the bursa: Corticosteroids are powerful anti-inflammatory drugs that are injected into the bursa to immediately suppress inflammation and relieve pain. With ultrasound guidance, the injection of corticosteroids is performed accurately and safely within the bursa, avoiding potential damage to the tendon, which could be caused by blind injection.
PRP for degenerative tendinopathy: The PRP technique involves taking a small amount of the patient's blood, which is centrifuged to separate platelet-rich-plasma. The plasma is then injected, under ultrasound guidance, into the site of injury and functions long-term by promoting healing through the growth factors found in platelets.
Barbotage for calcium deposits: If calcium deposits are identified during the ultrasound examination, they can be treated through Barbotage therapy, which involves flushing the deposits with saline solution and injecting anti-inflammatory medication into the bursa.

Ultrasound guidance is critical for the safety and accuracy of the therapeutic procedure, as it ensures the avoidance of surrounding organs, such as vessels and nerves, and optimizes the therapeutic outcome.

Conclusion

Although it is a painful pathological condition that creates difficulties in the patient's daily life, trochanteric bursitis can be effectively managed through accurate diagnosis and appropriate medical intervention. Ultrasound is a valuable tool both for the precise diagnosis of trochanteric bursitis through Hip Ultrasound, as well as for the treatment of the condition through ultrasound-guided, minimally invasive therapies.