There are important muscles which attach to the outer prominence of the thigh bone (greater trochanter of the femur) by wide flat tendons. The bony prominence is lubricated from the overlying skin by a fluid filled sac called the trochanteric bursa. This bursa can become inflamed (bursitis) because of overuse or due to small tears in the broad flat tendons of the gluteus medius and minimus. Pain is felt over this prominent area and the cardinal feature is that is painful to lie on the affected side. Diagnosis is confirmed on MRI or ultrasound scans and by excluding other hip conditions: occasionally pain coming from the hip joint is felt in this area.
The mainstay of treatment is injections of a cocktail of local anaesthetic and anti-inflammatory steroid into the area, ideally whilst visualising the area by ultrasound to ensure accuracy. Whilst two or three injections are sufficient for the majority of patients, more refractory cases may require injection with platelet rich plasma (PRP).
This is a new, but promising, technique which delivers the body’s own healing factors directly to the damaged area. Surgery for trochanteric pain is used as a last resort because its success rate is only 50-65%.