Gluteal tendinopathy which is more commonly known as “Trochanteric Bursitis” is the term we use to describe the pain which is felt on the outer aspect of the upper thigh that develops spontaneously mostly in middle age females. It is of gradual onset but on very rare occasions, may be associated with an injury. Often the pain progressively worsens and eventually becomes quite disabling. It may prevent the sufferer from lying on either the affected or the opposite side causing sleep disturbance and limiting walking distance because of pain. The pain is usually quite well localized over the trochanter, is made worse by standing and walking and as it progresses, there can be associated development of a limp.
For a long time this pain has been attributed to inflammation of the lubricating sack (bursa) called the “Trochanteric Bursa” which covers the bony prominence of each hip. The treatment instituted for this pain has always been directed at reducing the irritation in the bursa and involves local anaesthetic and cortisone injections, physiotherapy, muscle stretches, massage, and chiropractic and osteopathy treatments. These modalities of therapy can result in some improvement in the pain and have, up to now, been the main method of treatment for this pain.
If you have had any or all of these treatments and are no better, you have fallen into that group of patients whose pain is not due to bursitis at all but is caused by a tear in the underlying hip tendons. The tear separates the tendons from their bony attachments and results in abrasion of the tendon on the underlying rough bone. The irritation of the bursa is actually just “collateral damage” because the tendons are frayed by the tear and irritate the bursa. If the treatment is directed only to the bursa, then the underlying cause remains untreated and the pain will persist and perhaps worsen.
There is a simple and obvious reason for this condition to develop. When we take a step, we are standing with all our weight on one leg. To balance ourselves, the muscles around the hip joint that attach to the bony bump which can be felt on the side of the upper thigh, have to contract strongly. The force they need to exert to work properly varies between one and a half to three times our body weight. For the average 70 kg individual this is 150-200 kg. That is close to the weight of a 750 cc motor bike. If we take on average about 1,000,000 steps each year, it should not come as a surprise that the tendons in some individuals wear out and break down. Such tendon problems are familiar to many of us in the form of a ruptured Achilles tendon (heel tendon) and torn/ruptured rotator cuff (shoulder tendon). The size of the tear varies greatly from one individual to another but can be a few square centimetres or the entire tendon being separated. Interestingly, the amount of pain felt is not closely related to the actual size of the tear.
Gluteal tendinopathy is normally diagnosed with clinical examination and plain x-ray of the hip and pelvis and an MRI scan.
When the tendon is torn, Cortisone and oral medication may help the pain but won’t actually deal with the problem which will persist and slowly worsen. Washing your car will not make it go better if the gear-box is broken. Put simply, if the pain is severe enough and disabling enough, only surgical reconstruction of the tendon will fix the problem and permanently settle the pain.