Commentary by Dr. Joseph Hui
A few months ago, I wrote an article regarding the confusion and misdiagnoses surrounding chronic tendon problems. Today, I’m going to focus on another issue that is often misdiagnosed. This commentary is a companion article which focuses on one particular issue that is often misdiagnosed.
Bursa are little, fluid-filled, flat empty pillow cases that sit between tissues such as tendon and bone to reduce the friction when structures glide against one another. When those become injured, typically through direct trauma, the “pillow case” fills up with extra fluid and becomes more like a fluffy pillow, which results in bursitis. This newly expanded pillow can become painful, which then also pushes on adjacent structures and causes pain. In patients with lateral hip pain, this is almost never the case but is still commonly misdiagnosed as a trochanteric bursitis.
The pain on the outside of the hip generally starts without a particular mechanism of injury. It tends to hurt to walk, go up and down stairs and will often hurt at night while laying directly on the hip that is symptomatic. It tends to affect women between the ages of 30 and 60, but it can affect both genders once they are physically mature. The pain is usually described as a dull to strong ache on the side of the hip and doesn’t tend to radiate down the side of the leg. Anti-inflammatories like Advil (ibuprofen) and Aleve (naproxen) can be helpful but often are ineffective. This problem is often treated with a blindly injected steroid, which temporarily alleviates the pain. The vast majority of patients suffering from this will have pain that returns within 12 months if a steroid injection is the only treatment they receive. This plan typically results in a repeating cycle of chronic steroid injections only to be followed by temporary pain relief, which seems to become less and less effective over time.
In most cases, the pain actually stems from a nearby tendon called the gluteus medius. This acts like the rotator cuff of the hip. Over time, the tendon fibers become painful and develop into a tendinopathy, also known as tendonosis. Google the previous article title mentioned above for more on this process.
Gluteus medius tendinopathy, like other opathies and osis’, can heal over time if treated properly. A combination of eccentric exercises and tool-assisted cross friction massage often leads to a long-term fix. In many cases, using a form of regenerative medicine called platelet-rich plasma also can assist. For more, visit http://riverview.org/ortho.
