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Bursitis trochanterica - bursitis of the hip

General

The bursitis trochanterica is an inflammation of the bursae of the hip joint.

In the hip joint, there are three larger bursae that can not only be inflamed due to incorrect loading. The three types of bursitis of the hip joint involve proportions of the three gluteal muscles that attach to the thighbone. These are the gluteus maximus muscle, the gluteus medius muscle and the gluteus minimus muscle.

The bursae serve to virtually separate the bone and the muscle and form a sliding layer. In addition, they also dampen our movements. The so-called trochanter of the thigh bone is a part of the bone on which many muscles of the hip joint attach.

Consequently, the bursitis trochanterica is inflammation of the bursa, which is located between the three gluteal muscles and the upper part of the bone of the thigh.

frequency

It is difficult to say exactly how frequently bursitis of the hip joint occurs, as many forms of these diseases fortunately heal very well.

According to some studies, unilateral trochanteric bursitis is more common in both women and men than bilateral bursitis. Overall, more than half of the patients with bursitis are female.

On average, the disease occurs in 1-2: 1000 patients.

causes

Bursitis can be a result of stress during exercise.

In order to understand the causes of the development of a trochanteric bursitis, first of all the anatomy of the affected structures must be made clear. The rolling hill, a bony structure of the thigh, is a starting point of many muscles of the hip. This causes an enormous mechanical load in this area, which in turn is diverted to a large extent on the bursa, the bursa trochanterica. In a trochanteric bursitis, the mechanical burden on the bursa has become so great that it has become inflamed.

It is distinguished between the septic inflammations and the aseptic inflammations.

Septic inflammation is a disease caused by external agents such as bacteria. Inflammation caused by the bacterium Staphylococcus aureus is particularly common.

The aseptic bursitis is inflammation, which is triggered by the above-mentioned chronic stress. Especially sports that put a lot of stress on these muscles are therefore risk factors for the development of the trochanteric bursitis. Long-distance runners and wrestlers are often affected by the disease, as in these sports an enormous burden on the hip muscles is exercised. But even people who do not perform competitive sports, but have a Fehlbelastung can be affected by a trochanteric bursitis. As a result, the bursa are particularly irritated and it comes to a bursitis.

However, a bursitis can also be triggered by trauma, for example in the context of an accident. In the context of chronic diseases such as rheumatoid arthritis, inflammation of the bursa may also occur.

Other risk factors for the manifestation of bursitis may include a pelvic obliquity caused by legs of different lengths, a poor gait, too long standing, an unfamiliar burden or previous injury or hip surgery. Frequently, trochanteric bursitis also occurs in X-legged individuals. Here the angle between thigh head and thigh shaft is relatively small compared to unaffected persons ( <120 ° ). In addition to the knee joint, an X-leg position also affects the hip joint, including the bursa, which can often become inflamed in the affected person as a result of heavy stress.

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Occurrence of bursitis right / left / bilateral

The bursitis trochanterica occurs on both sides with the same probability, often even on both sides. If the symptoms are repeated on one side of the body, it may be helpful to subject your own gait or still image to closer observation. As already mentioned, the bursitis of the hip region is often due to a sustained pressure load on the hip joint. Not infrequently are responsible for bad postures, leg length differences, pelvic obliquity or a rest posture, which is taken in the context of chronic back pain. Also, leg deformities resulting from operations or lower extremity injuries can result in uneven loading of the hip joint.

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If a trochanteric bursitis prefers difficulties on one side of the body, it may be helpful to relieve the affected side by taking appropriate measures, such as the use of walking aids. Also, walking training together with a physiotherapist can help to compensate for stress. If the bursitis trochanterica occurs on both sides, the patient is often severely limited due to pain.

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symptoms

In the aseptic form of the bursitis of the hip joint, there is initially an increased pressure and friction feeling in the joint. The pain begins to increase slowly. If the load is not adjusted, the pain continues to increase until it comes to the typical signs of inflammation. Since concomitant tendinitis is also common on the thigh, it can also cause sharp pains during running, as the tendons of the thighs run near the bursa.

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In addition to the pain, the typical signs of inflammation are overheating, redness and swelling of the affected joint.
The four different signs of inflammation can occur in different degrees. Most of the pain occurs in front of the other three symptoms, or it is first perceived by the patient.

It is important to pay attention to this when the pain occurs instead of ignoring it and to start with a protection of the joint.

In the septic form of bursitis, in connection with an infection, usually minor injuries have preceded. Many patients report trauma. Even with this form, it comes to the typical signs of inflammation. Sometimes the septic form also causes fever and chills.

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diagnostics

Many doctors are satisfied because of the location of the clear signs of inflammation a diagnosis of bursitis of the hip joint.
Of course, the work experience of the doctor plays an important role. The pure eye diagnosis is usually supported by a sonography ( colloquially ultrasound ) of the hip joint.
In particular, the effusion caused by the inflammation can be recognized.

In addition, an X-ray can also be performed, also to exclude involvement of the bone.
However, especially with younger patients, it should be noted that exposure to X-rays also leads to radiation exposure. Therefore, sonography is usually chosen to help diagnose children.

Rarely, a diagnosis of the blood is performed.
In this case, the parameters that are typical for an inflammation are also changed. These include an increase in C-reactive protein ( CRP ) and an increase in blood sedimentation rate ( ESR ).

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In the septic form of the trochanteric bursitis, moreover, a microbiological detection of the often bacterial pathogen from the punctate of the inflammation is possible.

MRI with a trochanteric bursitis

The diagnosis of a trochanteric bursitis is not always easy. One reason for this is that the exact location of the bursae on the hip joint is not well known and varies slightly from patient to patient. If a suspected diagnosis of bursitis trochanterica is made on the basis of the patient's accounts and physical examination, an imaging procedure can help confirm the suspicion.

If the cause of chronic hip pain remains unclear despite earlier, less expensive examinations, such as ultrasound examinations, imaging can be performed using magnetic resonance imaging ( MRI ). This is especially true for patients with severe suffering and a long history of illness. This is a form of cross-sectional imaging that, unlike computed tomography (CT), works without X-rays and is based on the use of a strong electromagnetic field. The MRI scan is useful for suspecting Bursa trochanterica due to the better soft tissue imaging compared to conventional X-ray and CT scans. It is absolutely harmless to the patient.

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It should be noted, however, that some implanted pacemakers, prostheses and artificial heart valves are sometimes not MRI-suitable. Information about this usually provides the device or prosthesis passport.

therapy

If a bursitis trochanterica has been diagnosed by a doctor, a suitable treatment of the disease should be initiated as soon as possible. There are different options of the therapeutic measures, depending on the individual situation and preference of the person concerned. Particularly important for a successful therapy of aseptic bursitis of the hip joint is the preservation of the joint, since the overload is a frequent trigger of inflammation. Only by adequate protection of the affected structure, the existing inflammation can regress and a healing occur.

In addition, warm and cold compresses can be used to stimulate blood circulation.
In addition, NSAIDs ( non-steroidal anti-inflammatory drugs ) such as ibuprofen or acetylsalicylic acid are used to treat the pain. These drugs indirectly inhibit the further release of pain mediators.
It is particularly important that people who suffer from a tendency to gastric ulcer, these drugs not or only very weakly dosed or should only take in combination with a stomach protector.

In particularly severe cases of bursitis this can also be flushed with glucocorticoids.

In the treatment of septic bursitis of the hip joint, antibiotics are used to fight the bacteria. Here, too, mechanical relief is important so that consequential damage does not occur.

In some cases, the focus of inflammation is also punctured to drain the purulent discharge and thus relieve the joint.

As a rule bursitis bums relatively quickly. Of course, as with any other inflammation, it can also lead to severe cases, but luckily this is quite rare.

If, in spite of an existing bursitis trochanterica, the bursa is further loaded, chronic inflammation threatens, which under certain circumstances can only be cured surgically.
An operative therapy option is necessary if the non-invasive procedures described above were unable to cure or if there is a so-called peracute inflammation of the bursa.

With a peracute inflammation fast action becomes necessary, since otherwise it can come to a so-called sepsis and in the worst case even to the death of the affected person. Also, inflammations that occur after surgery often chronicle, which is why in these cases usually advised to an operative therapy.

There are two different surgical procedures to treat a trochanteric bursitis.

First, it is possible to remove the entire inflamed bursa. The removal of the inflamed sac removes the reason for the present symptomatology, which usually achieves a complete cure. In some cases, however, the affected joint may be compromised after surgery. This is related to the resulting scars, which inevitably occur due to removal of the bursa.

Another surgical procedure is the endoscopic mirroring of the bursa. Similar to a joint mirroring, the bursa is opened and treated minimally invasively. Especially with chronic inflammation of the bursa, this method is used. The advantage is that by leaving the bursa, the joint is hardly loaded and it comes only rarely to a restriction of the joint function.

Exercises with a bursitis of the hip

In the conservative treatment of a trochanteric bursitis moderate pain therapy, heat therapy and anti-inflammatory pain medication and moderate physiotherapeutic exercises can be used.

1. The so-called Tractus tibialis stretch is performed while standing. The healthy leg represents the mainstay and is crossed by the diseased leg. Then you should try to touch your toes with your legs outstretched. This position is held for 30 seconds and usually repeated three times.

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2. The leg lift should be performed on a gym mat on a supine position. Here, the muscles of the stretched diseased leg is briefly tense and the leg then raised about 8-10 cm. This position should be held for a few seconds and repeated three times.

3. The hip extension works similarly. This exercise is performed in prone position. The affected leg is stretched out a few inches from the mat.

4. The squat bend is a squat that is carried out with the back to the wall and supported by an exercise ball between the back and the wall.

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Illustrative examples of all exercises can be found on the internet for everyone. The extent of physical activity and the type of exercises used should be discussed in advance with the attending physician.

Operation with a bursitis of the hip

Hysteria surgery is not the treatment of choice for bursitis trochanterica. Much more is placed on conservative procedures such as body sparing, warmth and taking so-called NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen.

In chronic cases or when the patient is under a high level of suffering, surgery may be considered. Here are two methods. The so-called bursoscopy is the reflection of the bursa with a conventional arthroscope, as it is also used in knee-joint mirroring. In this case, the inner synovial layer can be removed to parts. By removing this sliding layer, the inflammation can be contained in many cases. Not only does the patient benefit from the reduced scarring that results from this minimally invasive procedure, but he also enjoys the functional benefits of remaining slippery portions.

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However, the standard procedure for surgical treatment of a trochanteric bursitis is still the bursectomy. Here, the inflamed bursa is removed in an open surgical procedure. However, the larger surgical field also leaves larger scars and the time of sparing after surgery is much longer than during the bursoscopy. Finally, the loss of function due to the complete removal of the bursa may have a detrimental effect on the resilience of the joint.

Clearly against a surgical intervention speaks a bacterial inflammation of the bursa. Here must not be operated due to the risk of infection. The same applies to a trochanteric bursitis, which occurs as part of a rheumatic disease with simultaneous inflammation of the hip joint.

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Bicycling on a bursitis of the hip

A cornerstone of the therapy of a trochanteric bursitis is the adequate sparing of the affected anatomical structures.

If the physical activity is maintained despite illness, it may be that the disease progresses further or the healing process is significantly delayed. This is especially true for running sports, where large loads on the hip region occur.

It should be noted, however, that too extensive protection or even immobilization of the affected limb can also have negative effects on the stability of the joints or the status of the muscles. Further illnesses can be the consequence.

Although bursitis trochanterica may occasionally occur in cyclists, bicycling can provide a way to compensate for movement, and strengthen muscles, bones and joints when protected. Here it depends on the patient, who should listen to the signals of his body.

If pain also exists while cycling, it is strongly advised against. Training on the bike should also be done in a moderate way. Too sustained and heavy burdens could worsen the clinical picture.

Jogging with a bursitis of the hip

As already mentioned, the physical protection is of great importance for the therapeutic success of a trochanteric bursitis. The disease is triggered mainly by excessive stress on the hip joint, which is the case especially in running sports. Runners should abstain from jogging as part of an illness to positively influence the course of the disease. If this is absolutely not possible, try to avoid at least intermittent activities with less stress. Here Nordic Walking offers an alternative. Patients should discuss any type of physical activity with their attending physician.

prevention

A run analysis can be useful here.

If, as a result, there is an increased burden of bursitis of the hip joint, a measurement of the legs and a running analysis may make sense.
This type of abuse can often be compensated by suitable shoes and / or inserts.

If, especially after participating in particularly articularly stressful sports such as wrestling or bodybuilding to bursitis, these sports should be avoided in the future and be replaced by joint-gentle sports such as swimming or cycling.

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In general, it is important not to completely abstain from sports after a thorough inflammation, but simply to optimize the chosen sport something. It is important on the one hand to pay attention to the sequence of movements and on the other to pay attention to how you can relieve the hip joint without, for example, the knees in addition to burden.

At the first signs of renewed bursitis of the hip joint, should also be started here with the protection. Regular and properly performed exercise can also protect you from re-inflammation in the long run. Particular attention should be paid to regular stretching exercises and exercises to strengthen the muscles, as this relieves the joint through a strengthened musculature.

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Even good physiotherapy can be useful in such strengthening exercises of the surrounding muscles, especially if the bursitis occurs more frequently.

For the prevention of trochanteric bursitis no non-steroidal anti-inflammatory drugs should be taken, as they mainly take the pain but do not remedy the cause of the disease.

Patients who are more likely to have stomach ailments should refrain from using this type of pain medication or at least only use it in combination with a stomach protection product.

If bursitis of the hip joint regularly occurs in children, a movement and gait analysis should first of all analyze the movements of the child in order to prevent the inflammations resulting from an incorrect sequence of movements.
If this is the case nevertheless, the children can learn the correct movements through a therapy in order to avoid further bursitis in the future.

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