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