Pain over the out aspect of the hip, on the boney prominence is relatively common. Historically the presumed diagnosis was “bursitis” and in fairness, a cortisone injection to that bursa often relieved the pain, and although it might need to be repeated once or twice, the treatment worked. Sometimes the pain keeps recurring. MRI scan should be undertaken.
Two other common tendon conditions in the body can be reasonably compared with “trochanteric pain syndrome”. Tennis elbow is an overuse condition on the outer aspect of the elbow. It often responds to autologous blood injections, if it isn’t responding, often there is a deep surface tear which requires surgical repair. Shoulder tendon tears usually occur in middle to late age and if not responding to cortisone, then surgical repair is performed, along with making more space for the tendon. As cortisone doesn’t repair the tear, in active younger patients some surgeons reasonably argue surgery should be the first line treatment.
How does this fit with trochanteric pain? Most cases relate to the underlying gluteal tendons. If no tear – perhaps ABI or PRP injections to the tendons should be undertaken. If there is a tear, then surgical repair and lengthening the overlying ITB should be considered. It might still be reasonable to hope the simple treatments achieve enough. Surgery is a major undertaking that might require two crutches initially and one crutch up until eight or twelve weeks from surgery.
This MRI picture of shows the hip joint and the trochanter in cross section.. The white arrow demonstrates fluid under one of the tendons, ie it is not attached to the bone where it should be. Fluid more laterally demonstrates a defect in gluteus minimus as well.
For those cases treated with injection of cortisone into the bursa, having the patient lay on their back with the leg a little “abducted” or positioned with the foot away from the midline creates more “potential space” for the needle and injection fluid to run into. This way the injection is typically less painful and more accurately placed.
Mr David Mitchell