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Greater Trochanteric Bursitis M70.60 726.5

 

synonyms:

Greater Trochanteric Bursitis ICD-10

Greater Trochanteric Bursitis ICD-9

  • 726.5 (Enthesopathy of the hip region)

Greater Trochanteric Bursitis Etiology / Epidemiology / Natural History

  • Results from friction between the greater trochanter and the iliotibial band during hip flexion and extension causeing microtrauma and bursal inflammation.
  • Chronic greater trochanteric bursitis can lead to a painful limp and sleep difficulty

Greater Trochanteric Bursitis Anatomy

  • The trochanteric bursa lies between the iliotibial band and the greater trochanter.

Greater Trochanteric Bursitis Clinical Evaluation

  • Pain and tenderness over the affected greater trochanter. Pain is often worse when first rising from a seated / recombent position.
  • Increased pain with adduction and internal rotation.
  • Generally unable to lie on affected side.
  • Pain may radiate into the buttock or down the leg into knee or ankle.
  • Clinic Note

Greater Trochanteric Bursitis Xray / Diagnositc Tests

  • A/P pelvis, A/P and lateral of the affected hip. May demonstrate rounded or irregular calcific deposits around the greater trochanter.
  • Consider MRI / bone scan if concerned for occult fracture or tumor.

Greater Trochanteric Bursitis Classification / Treatment

  • Initial treatment: physical therapy, NSAIDs, ICE, corticosteriod injection, short term cane use.
  • Chronic Recalcitrant: open or arthroscopic bursectomy.
  • Arthroscopic bursectomy: proximal portal just posterior to the tip of the trochanter. Distal portal just posterior to the inferior aspect of the bursa. (Baker, CL)

Greater Trochanteric Bursitis Associated Injuries / Differential Diagnosis

  • Lumber degenerative disc disease
  • Lumbar spinal stenosis
  • Hip arthritis
  • Limb-legth discrepancy
  • Painful hardware (after ORIF of hip fractures)
  • Metastatic tumor
  • Sciatica
  • Septic arthritis
  • Snapping hip (Coxa Saltans)

Greater Trochanteric Bursitis Complications

  • Greater trochanteric bursitis injection risks: infection, allergic reaction to local anesthetic or steriod preparation, fat atrophy, skin depigmentation
  • Chronic pain
  • Limp
  • Difficulty sleeping

Greater Trochanteric Bursitis Follow-up Care

  • May consider repeat injection if initial injection fails or symptoms return. Avoid multiple steriod injections.

Greater Trochanteric Bursitis Review References

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