Trochanteric bursitis / Greater trochanteric pain syndrome
Referrals for USS guided steroid injections to RCHT Clinical Imaging have restarted. Please note there is limited capacity so referrals should be reserved for patients with significant disabling and persistent symptoms. Please click here for full details
Covid-19 Update: Corticosteroid Injections During The Coronavirus Pandemic
Please ensure and document that a discussion has happened that the patient is aware corticosteroid injections pose a possible and quantifiably unknown increased risk of, and complications from, Covid and the possible risk of reduced Covid vaccine efficacy prior to performing. Secondary care referrals for steroid injection, including image guided injections, require the patient to be counselled and risk assessed prior to referral and this documented in the referral. Please see guidance available here for detailed information.
Trochanteric pain with local tenderness is often due to trochanteric bursitis or abductor tendinopathy
Exclude red flags, inflammatory conditions and other hip conditions with similar presentations and associated conditions of the lumbar spine, hip and knee.
For patients under the age of 40, please follow the Young Adult Hip Pain (kernowccg.nhs.uk) guidelines.
Isolated pain over the greater trochanter settles in 64% of patients after 1 year and 71% over 5 years.1
Primary Care Management2
Rest the affected hip by avoiding activity that may worsen the pain such as repetitive movements and avoid lying on the hip where possible.2
Ice pack for 10-20 minutes several times/day2
Analgesia such as paracetamol and/or ibuprofen if tolerated and no contra-indications
Weight loss
Smoking cessation
Steroid injections – trial of 2 injections
Physiotherapy
Consider referral to MSK Interface if above has failed to improve symptoms
Red Flags
Emergency Department or discuss with Orthopaedic SHO on call
Severe hip pain and sudden inability to weight bear +/- history of fall RCHT, not community hospital/minor injury clinics
Sudden severe significant deterioration of chronic hip pain
Sudden change in true leg length
Suspected/confirmed avascular necrosis
Suspected sepsis Admit via Orthopaedic SHO
Systemically unwell
If concern regarding suspected new malignancy please refer via 2 Week Wait Criteria.
X ray suggests the possibility of Sarcoma
Myeloma work up
http://rms.kernowccg.nhs.uk/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/haematology/mgusmyeloma
Common metastases to bone: Prostate, breast, renal, lung, thyroid 2WW/Oncology if known primary/unknown origin
Inflammatory causes
New symptoms of inflammation suggesting systemic inflammatory joint disease, workup and refer rheumatology
MSK Interface
Referral Criteria
Patients with shoulder, hip, knee problems including sports medicine problems of these joints whereby:
-
Conservative measures have failed including a course of tailored physiotherapy AND one or more of the following:
- Diagnostic uncertainty
- Uncertain if surgery is indicated
- Patient is medically unfit or declining surgery
Exclusion Criteria
· Red flag pathology
· Severe symptoms with functional limitations and willingness for surgery
· Previous joint replacement or significant major surgery to the same joint
· Patients under 16 years
· Hand elbow and foot problems
· Spinal problems (see Spinal Interface)
· Multiple/inflammatory arthropathy
· Lumps, bumps, ganglia
An X ray within 6 months is required for the referral
References
1. Pain arising from the hip in adults. British Orthopaedic Association, British Hip Society and Royal College of Surgeons Commissioning Guide, 2017.
2. Greater Trochanteric Pain Syndrome (Trochanteric Bursitis). Clinical Knowledge Summaries, National Institute of Clinical Excellence, April 2021
Date reviewed 22/02/2022
Next review due 22/02/2023
Sifter name Dr Rebecca Hopkins
Version No. 1.2