The trochanteric bursitis is classified according to cause and course:

1. Acute trochanteric bursitis: Sudden onset inflammation, usually caused by overuse or trauma.

2. Chronic trochanteric bursitis: Long-lasting or recurring symptoms, often caused by repeated irritation.

3. Aseptic bursitis: Non-infectious inflammation, often due to mechanical stimuli or misalignments.

4. Septic bursitis: Infectious inflammation caused by bacterial pathogens, often accompanied by fever and severe pain.

5. Traumatic bursitis: Caused by blows, bruises, or repetitive stress.

The causes of trochanteric bursitis can include mechanical, inflammatory, and infectious factors:

• Mechanical irritation:
  • Repeated movements or prolonged pressure on the hip, for example, from lying on one side for an extended period.
  • Overstrain from intense physical activities such as running or hiking.
• Orthopedic misalignments:
  • Leg length discrepancies, knock knees, or pelvic misalignments that lead to overstrain of the hip muscles.
• Muscular imbalances:
  • Overstrain or weakness of the abductor muscles, particularly the gluteus medius muscle.
• Inflammatory diseases:
  • Rheumatoid arthritis, gout, or other systemic inflammations.
• Traumatic injuries:
  • Direct blows to the hip or falls that irritate the bursa.
• Infections:
  • Penetration of bacteria into the bursa through injuries or injections.

The symptoms of trochanteric bursitis are often characteristic and include:

• Local pain: Burning or dull pain on the outside of the hip, often radiating to the thigh.
• Tenderness: Pain when pressure is applied to the greater trochanter, especially when lying on the affected side.
• Movement restrictions: Pain during certain movements such as walking, climbing stairs, or prolonged exertion.
• Swelling and redness: Rarely visible, except in septic bursitis.
• Night pain: Increased discomfort at rest or when lying on the affected side.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

- Medical history:

- The doctor inquires about the duration and intensity of the symptoms, possible overuse, and pre-existing conditions.

- Physical examination:

- Palpation of the hip to locate the pain and assess mobility.

- Functional tests such as the Faber test or the Trendelenburg test to identify abductor weaknesses.

- Imaging:

- Ultrasound: Visualization of fluid accumulations or inflammation in the bursa.

- MRI: Detailed assessment of soft tissues and surrounding structures.

- X-ray: Exclusion of bony changes such as osteoarthritis.

- Laboratory tests:

- Blood tests to determine inflammatory markers or infections.

- Aspiration of the bursa for analysis if septic bursitis is suspected.

Conservative Therapy

In most cases, trochanteric bursitis can be successfully treated without surgical intervention:

• Immobilization and Relief:
  • Avoidance of stress and adjustment of training or daily activities.
• Medication Therapy:
  • NSAIDs: To relieve pain and inflammation.
  • Antibiotics for infectious bursitis.
• Physiotherapy:
  • Exercises to strengthen the hip muscles, especially the abductors.
  • Stretching shortened muscles to reduce stress on the bursa.
• Local Applications:
  • Cold therapy for acute pain and inflammation.
  • Heat therapy to relax muscles in chronic conditions.
• Injections:
  • Corticosteroids for rapid relief of inflammation.

Surgical Therapy

In cases of persistent symptoms or complications, surgery may be necessary:

• Bursectomy: Surgical removal of the inflamed bursa in cases of recurrent inflammation.
• Correction of Misalignments: Treatment of underlying orthopedic problems.
• Minimally Invasive Procedures: Arthroscopic interventions for quick recovery.

To prevent and alleviate symptoms, the following measures are recommended:

1. Strengthening of the hip muscles: Targeted training of the abductors to stabilize the hip.
2. Adjustment of load: Avoidance of repeated overloads or unfamiliar activities.
3. Correction of misalignments: Use of orthopedic insoles for leg length differences or other misalignments.
4. Regular exercise: Promotion of mobility and flexibility of the hip through moderate activity.
5. Early treatment: At the first signs of symptoms, a doctor should be consulted in a timely manner.