Hi there,

Trying so hard to find an answer and doing much research. I was on another chat board and someone mentioned bursitis, so I did some research. I came up with the following and I think it's what's going on - I'll discuss with doc when he calls to give results of MRI (if nothing shows there).

Trochanteric Bursitis -

What is Trochanteric Bursitis?
Trochanteric bursitis is a condition affecting the side -- or lateral aspect -- of the hip. Although trochanteric bursitis usually affects middle-aged or elderly persons, women more often than men, it can develop in younger people also. As in other forms of bursitis, there is swelling in the bursa causing pain and inflammation.

The thighbone, the longest, heaviest, and strongest bone in the body, is known anatomically as the femur. At its top, or proximal end, it articulates with the hipbone, technically known as the pelvic girdle. There is a large protrusion at this end known as the femur head. This ball-shaped section of bone fits into the pelvic girdle to form a ball-and-socket joint. The greater trochanter is palpable protrusion at the top of the femur, extending laterally in the direction of the hip.

It is the point of attachment for several muscles of the thigh and pelvis. The muscles of the thigh are very powerful, and they contribute to locomotion, stability, and the maintenance of an upright posture. Because a number of muscles insert at the greater trochanter, there are many bursae cushioning the sensitive interfaces between them and the bone. When these bursae become inflamed, the result is trochanteric bursitis.

Causes of Trochanteric Bursitis?
Trochanteric bursitis is somewhat similar to bursitis of the shoulder. It is often encountered in athletes who overuse the hip areas without proper stretching and warm-up. It may also accompany any type of lower back pain, probably because the pain causes alterations in habitual ways of walking. Sometimes differences in the lengths of the legs contribute to trochanteric bursitis.

Trochanteric bursitis may be occupation-related. Cashiers and wallpaper hangers, for example, have jobs demanding multiple repetitive actions that may lead to trauma to the lateral thigh area. Patients who must lie on one side of their bodies for extended periods due to an injury may also develop pain over the trochanteric bursa. Bucket seats or tight fitting chairs seem to aggravate the problem.

Some infections, such as staphylococcus and tuberculosis, are associated with trochanteric bursitis. It is not uncommon to see this condition in relation to gout and arthritis as well. Patients with underlying surgical wire, implants, or scar tissue in the hip area may also develop trochanteric bursitis.

Sometimes people who have had an injury to the spine, hip, knee, or ankle develop trochanteric bursitis. Injury to any of these areas may cause an alteration in gait that may irritate the structures overlying the greater trochanter. Scoliosis also disrupts the normal mechanics of gait.

Direct falls on the lateral aspect of the hip, as experienced by ice skaters or dancers, repetitive athletic overuse, or multiple traumatic impacts of a lesser severity can all lead to chronic trochanteric bursitis. If the inflammatory process is acute and ongoing, it can cause reactive tissue to form within the bursa. With repetitive stress, the bursae of the hip may become an active inflammatory center aggravated by any activity involving the surrounding muscles.
Symptoms of Trochanteric Bursitis and Meralgia Paresthetica?
Most people who suffer from trocanteric bursitis have difficulty walking. Many will walk with a limp, and some will find that they cannot walk at all, due to the intensity of pain. All patients complain of aching over the trochanteric area and lateral thigh. This pain may be acute at the onset of the disease, or it may build up gradually over time, sometimes lasting for many months or even years. In chronic cases, discomfort may be more vague and it may be difficult to describe its exact location. Walking with the legs apart will help but it is rarely done except at home because it looks different.

The pain experienced with trochanteric bursitis can have a radiating quality, and must be distinguished from that associated with lumbosacral spine disease or sciatica. If the pain radiates down to the knee and throughout the extent of the iliotibial band of muscles running along the outside of the thigh, lumbosacral spine disease should be suspected as the cause of discomfort.

Diagnosis of Trochanteric Bursitis?
Disorders of the hip are diagnosed by direct physical examination. With the patient lying on his or her side or back, pressure is placed over the ridge of the greater trochanter. This maneuver usually elicits pain that becomes more powerful with external rotation of the hip.

X-rays are often used, and many times calcium deposits or bony spurs are seen. A rheumatological evaluation for the condition known as fibromyalgia may be necessary if the patient has a history of multiple tendon disorders such as shoulder bursitis or low back pain. Fibromyalgia is a common rheumatic syndrome that causes pain and weakness in the muscles. Chronic pain or multiple disorders often result in depression, difficulty sleeping, or other psychiatric symptoms. It is important to recognize whether the cause of pain may be an underlying systemic condition.

Treatment for Trochanteric Bursitis?
The first step in treatment of trochanteric bursitis is rest. It is important to identify the activities which cause or aggravate the problem, and to make modifications accordingly. Weight loss often contributes to the overall management of trochanteric bursitis. Shoe lifts may help if there is a discrepancy in leg length.

Regularly applying ice or heat to the hip can produce relief. In addition to icing the affected area for 15 to 20 minutes two to three times a day, occasional treatments such as ultrasound, acupuncture, and deep massage may be beneficial. A physical therapist can demonstrate pelvic tilt exercises as well as strengthening and stretching exercises for the leg muscles; if done regularly, these may help heal the condition over time. Liniments may bring some measure of short-term relief.

Doctors normally recommend non-steriodal anti-inflammatory drugs (NSAIDs) such as ibuprofen for pain relief. If these (combined with rest, ice, and physical therapy) are not successful, then the patient may be a candidate for an injection of corticosteroid and local anesthetic into the region of the affected bursa. Several injections may be necessary over a several month period to completely resolve the problem.

Surgery is advised as a last resort, only if an underlying cause has been elucidated and the treatment regimen fails to bring significant relief. The surgical procedure may consist of releasing the iliotibial band, and removing the bursal sac and any calcified tissue.

Complications and Conclusion?
Trochanteric bursitis due to underlying conditions like arthritis or gout is more difficult to treat and may require many lifestyle adjustments in order to avoid the activities that seem to cause or aggravate the bursitis.

Even in properly selected patients the success rate for surgery still is not high. Unless a very obvious offending agent is found within the trochanteric bursa during a preoperative work-up (such as a complication involving a prosthetic implant), surgery is best pursued only as a last resort.

Successful long-term treatment for trochanteric bursitis,may involve effort on the part of the patient to change his or her style of life, occupation, or activities. Improving one’s health through weight loss or gentle exercise is often a decisive component of treatment.

Tranquility