What is it about ?
The femur is the longest bone in our body. It goes from hip to knee. The upper end of the femur ends in a rounded head, the femoral head, which fits perfectly into the cavity of the iliac bone (called the acetabulum or acetabulum), the whole forming a joint. The femoral head is connected to the body of the femur by a narrower portion called the femoral neck. At the base of this head is a bump (protuberance). This is the trochanter. The trochanter strengthens the iliac head and also serves as an attachment point for the tendons of several muscles. Between the trochanter and these tendons, there is a small cushion filled with fluid (serous bursa) which prevents excessive friction between the two.
Trochanteric pain is caused by direct trauma such as an accident, or by inflammation of one of the tendons or the bursa. Overwork, common in endurance sports, is often the root of the problem, leading to minor but repeated injuries or abnormal friction. Another important cause is a particular gait. Back problems, difference in leg lengths, osteoarthritis in the knee or even ankle problems can interfere with walking and lead to overloading of the hip, which causes inflammation of the bursa (bursitis) or tendon irritation (tendinopathy).
Where does it occur?
Trochanteric pain occurs mainly in middle-aged and elderly women. Being overweight is a risk factor. Endurance athletes like marathon runners for example can also suffer.
How to recognize it?
The main symptom is pain in the trochanter, upper and outer side of the hip, and along the thigh. The pain may radiate to the upper part of the pelvis or to the knee. Walking, climbing stairs, and sleeping on the affected side can trigger the pain. Pressing on the painful area indicates exactly where the lesion is. Lifting the leg sideways is usually painful. The pain also increases when standing with your legs crossed, you tilt your trunk to the other side.
How is the diagnosis made?
Complaints are usually very characteristic, so the diagnosis is quickly made. During his examination, the doctor will move the hip in all directions. With trochanteric pain, some of these movements are painful. The doctor will also ask you to move your hip in all directions yourself. This will allow him to detect possible pain and inflammation in a tendon. He will finally determine the exact location of the inflammation by exerting local pressure. Technical examinations, such as an x-ray and an ultrasound, are unnecessary. If the doctor suspects a gait abnormality, he or she may refer you to a specialist for a gait analysis.
What can you do ?
If you have trochanteric pain, relieve your hip. Temporarily stop endurance sports and stop going for long walks. Also avoid efforts going uphill. Once the pain is gone, you can resume your activities gradually. But be sure to get back to it gently! Applying ice several times a day can help. The physiotherapist can teach you specific stretching exercises that improve the flexibility of the affected muscles.
What can your doctor do?
If the symptoms do not improve on their own and continue to bother you, an injection of cortisone at the painful site is the treatment of choice. If necessary, a new injection is given after 3 to 4 weeks. Classical nonsteroidal anti-inflammatory drugs (NSAIDs) are less helpful. They help reduce pain, but do not heal.