Trochanteric Bursitis/Tendinitis

Tendinitis and bursitis are inflammation or degeneration (breakdown) of the soft tissue around muscles and bones.

Trochanteric bursitis is inflammation of the bursa (fluid-filled sac near a joint) at the outside (lateral) point of the hip known as the greater trochanter. When this bursa becomes irritated or inflamed, it causes pain in the hip. This is a common cause of hip pain.

Tendinopathy (tendon pathology) describes two conditions that are likely to occur together: tendon inflammation, known as tendonitis, and tiny tears in the connective tissue, in or around the tendon, known as tendinosis. The most common hip tendinopathy is gluteal tendinopathy.Trochanteric Bursitis

 Symptoms

Tenderness along the tendon or its sheath (outer covering), or at one specific point in the tendon, suggests tendinitis. Pain occurs when the muscle to which the tendon is attached is worked against resistance.

Trochanteric bursitis typically causes the following symptoms:

  • Pain on the outside of the hip and thigh or in the buttock.
  • Pain when lying on the affected side.
  • Pain when you press in on the outside of the hip.
  • Pain that gets worse during activities such as getting up from a deep chair or getting out of a car.
  • Pain with walking up stairs.

The hip joint. The greater trochanter is the ridge at the top of the femur.

Causes

Trochanteric bursitis can result from one or more of the following events:

  • Injury to the point of the hip. This can include falling onto the hip, bumping the hip into an object, or lying on one side of the body for an extended period.
  • Play or work activities that cause overuse or injury to the joint areas. Such activities might include running up stairs, climbing, or standing for long periods of time.
  • Incorrect posture. This condition can be caused by scoliosis, arthritis of the lumbar (lower) spine, and other spine problems.
  • Stress on the soft tissues as a result of an abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a joint).
  • Other diseases or conditions. These may include rheumatoid arthritis, gout, psoriasis, thyroid disease or an unusual drug reaction. In rare cases, bursitis can result from infection.
  • Previous surgery around the hip or prosthetic implants in the hip.
  • Hip bone spurs or calcium deposits in the tendons that attach to the trochanter.

Bursitis is more common in women and in middle-aged or elderly people. Beyond the situations mentioned above, in many cases, the cause of trochanteric bursitis is unknown.

Tendinitis can occur from a sudden intense injury. Most often, though, it results from a repeated, minor injury of that tendon. Doctors call this repetitive stress or overuse. For example:

  • Painting a ceiling for four hours or more, typing long hours, improper body position while using a keyboard, chopping, cutting or sawing may result in tendinitis or bursitis hours or days later.
  • Tight clenching while using hand tools or while driving a long time.
  • Using a backhand, mainly single handed, in an early-season game of tennis (“tenniselbow”).
  • Wearing improper running shoes or not getting the proper training before sports.

Immediate Treatment

RICE: Rest, Ice, Compression and Elevation.

Danger Signals

Danger signs include rapid worsening of pain, redness and swelling, or sudden inability to move a joint.

 

Hip Labral Tear

A hip labral tear involves the ring of cartilage (labrum) that follows the outside rim of the socket of your hip joint. In addition to cushioning the hip joint, the labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket.

 Causes

Injury is still a major cause for labral tears. Anatomical changes that contribute to labral tears combined with repetitive small injuries lead to a gradual onset of the problem. Athletic activities that require repetitive pivoting motions or repeated hip flexion cause these type of small injuries. Athletes who participate in such sports as ice hockey, soccer, football, golf and ballet are at higher risk of developing a hip labral tear. Structural abnormalities of the hip can also lead to a hip labral tear.

Symptoms

Pain in the front of the hip (most often in the groin area) accompanied by clicking, locking, or catching of the hip are the main symptoms reported with hip acetabular labral tears. Joint stiffness and a feeling of instability where the hip and leg seem to give away are also common. The pain may radiate to the buttocks, along the side of the hip, or even down to the knee.

Symptoms get worse with long periods of standing, sitting, or walking. Pivoting on the involved leg is avoided for the same reason (causes pain). Some patients walk with a limp or have a positive Trendelenburg sign (hip drops down on the right side when standing on the left leg and vice versa).

The pain can be constant and severe enough to limit all recreational activities and sports participation.

 

Arthritis of the Hip

Also known as degenerative joint disease or age-related arthritis, osteoarthritis is more likely to develop as people get older, but it may also develop after an injury.

Osteoarthritis occurs when inflammation and injury to a joint (such as the hip) causes a break down of the cushion of cartilage tissue. In turn, that breakdown causes pain, swelling, and deformity. Cartilage is a firm, rubbery material that covers the ends of bones in normal joints. It is primarily made up of water and proteins. Although cartilage may undergo some repair when damaged, the body does not grow new cartilage after it is injured.

The changes in osteoarthritis usually occur slowly over many years. There are, though, occasional exceptions.

Causes

The causes of osteoarthritis of the hip are not known. Factors that may contribute include joint injury, increasing age, and being overweight.

In addition, osteoarthritis can sometimes be caused by other factors:

  • The joints may not have formed properly.
  • There may be genetic (inherited) defects in the cartilage.
  • The person may be putting extra stress on his or her joints, either by being overweight or through activities that involve the hip.

Symptoms

  • Joint stiffness that occurs as you are getting out of bed
  • Joint stiffness after you sit for a long time
  • Any pain, swelling, or tenderness in the hip joint
  • A sound or feeling (“crunching”) of bone rubbing against bone
  • Inability to move the hip to perform routine activities such as putting on your socks.

 

Femoroacetabular Impingement

In FAI, bone overgrowth — called bone spurs — develop around the femoral head and/or along the acetabulum.Because they do not fit together perfectly, the bones rub against each other during movement. Over time this friction can damage the joint, causing pain and limiting activity.

There are three types of FAI: pincer, cam, and combined impingement.

  • Pincer. This type of impingement occurs because extra bone extends out over the normal rim of the acetabulum. The labrum can be crushed under the prominent rim of the acetabulum.
  • Cam. In cam impingement the femoral head is not round and cannot rotate smoothly inside the acetabulum. A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum.
  • Combined. Combined impingement just means that both the pincer and cam types are present.
  
(Left) Pincer impingement. (Center) Cam impingement. (Right) Combined impingement.

Causes

FAI occurs because the hip bones do not form normally during the childhood growing years. It is the deformity of a cam bone spur, pincer bone spur, or both, that leads to joint damage and pain. When the hip bones are shaped abnormally, there is little that can be done to prevent FAI.

It is not known how many people have FAI. Some people may live long, active lives with FAI and never have problems. When symptoms develop, however, it usually indicates that there is damage to the cartilage or labrum and the disease is likely to progress.

Because athletic people may work the hip joint more vigorously, they may begin to experience pain earlier than those who are less active. However, exercise does not cause FAI.

Symptoms

The most common symptoms of FAI include:

  • Pain
  • Stiffness
  • Limping

Pain often occurs in the groin area, although it may occur toward the outside of the hip. Turning, twisting, and squatting may cause a sharp, stabbing pain. Sometimes, the pain is just a dull ache.

 

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