Bursitis of hip
Pro Research Analysisby 
Searched over 200M research papers
Understanding Bursitis of the Hip: Trochanteric and Iliopsoas Bursitis
Trochanteric Bursitis: Symptoms, Diagnosis, and Treatment
Symptoms and Prevalence
Trochanteric bursitis, also known as greater trochanter pain syndrome, is a common condition characterized by chronic, intermittent aching pain over the lateral aspect of the hip. This condition is most prevalent between the fourth and sixth decades of life but can occur in all age groups . It is often associated with pain and functional limitations, making daily activities challenging for those affected .
Diagnosis
Diagnosing trochanteric bursitis can be elusive, especially if symptoms are atypical. Clinical signs are crucial for diagnosis, as laboratory tests and radiologic signs often do not contribute significantly . In some cases, the condition may be misdiagnosed due to overlapping symptoms with other pathologies such as lumbar spine arthrosis or ipsilateral hip damage .
Treatment Options
Treatment for trochanteric bursitis typically includes physical therapy, analgesics, and local glucocorticoid injections. Local corticosteroid infiltration has been shown to provide rapid and prolonged pain relief, making it a preferred treatment option 12. In a study of 72 patients, 90.3% experienced significant improvement after one to three local treatments with corticosteroids and anesthetics .
Controversies and Misdiagnoses in Trochanteric Bursitis
Inflammatory Component Debate
Recent studies have questioned the inflammatory nature of trochanteric bursitis. Histological analysis of bursal samples from patients undergoing hip replacement surgery showed no evidence of acute or chronic inflammation, suggesting that the term "trochanteric bursitis" might be a misnomer . This finding implies that clinicians should consider alternative diagnoses for lateral hip pain .
Pseudotrochanteric Bursitis
In some cases, patients initially diagnosed with trochanteric bursitis may actually suffer from other conditions such as lumbar radiculopathy, lumbar facet syndrome, or entrapment neuropathies. These conditions can mimic the symptoms of trochanteric bursitis, leading to misdiagnosis and ineffective treatment . Selective neuroblockade can aid in differentiating these conditions from true trochanteric bursitis .
Iliopsoas Bursitis: A Rare but Significant Condition
Symptoms and Diagnosis
Iliopsoas bursitis is a less common cause of hip pain, often presenting with anterior hip pain and sometimes an anterior snapping hip. It is frequently associated with conditions like rheumatoid arthritis or osteoarthritis of the hip 48. Diagnosis is typically based on clinical examination, though real-time ultrasound can be useful for confirmation .
Prevalence and Complications
Iliopsoas bursitis is relatively rare but can be underdiagnosed. In patients with end-stage hip osteoarthritis, the prevalence of iliopsoas bursitis was found to be 6.8%, with some cases causing significant neurological symptoms and swelling due to compression of the femoral nerve and vessels .
Treatment Challenges
Nonoperative management of iliopsoas bursitis is not well established, and surgical management does not always guarantee success . Further research is needed to develop effective diagnostic and treatment protocols for this condition .
Conclusion
Bursitis of the hip, encompassing both trochanteric and iliopsoas bursitis, presents a complex clinical picture. While trochanteric bursitis is common and often successfully treated with corticosteroid injections, its inflammatory nature is debated, and misdiagnosis is possible. Iliopsoas bursitis, though rarer, requires careful diagnosis and management due to its association with other hip pathologies and potential for significant complications. Accurate diagnosis and tailored treatment plans are essential for effective management of these conditions.
Sources and full results
Most relevant research papers on this topic