Troch Bursitis

[Diane]

Hi Steve,
I scanned 2 patients today which I was thinking could be troch bursitis but also I sometimes wonder.. is there ever a time you see fluid in the troch bursa and call it physiological? Do you call it only if they are tender?

Case 1 – Tender lateral trochanter and I thought I saw some fluid pooling in the posterior aspect of the hip. Is this appearance typical of troch bursitis to you?
Case 2 – Tender lateral trochanter also. Thought I saw some bursal thickening. There seems to be a cystic area which… ?troch bursa.

Also is there a specific term you use for the move you use when you keep the patient’s knees together but separate the ankles? Anyway, when I did that movement for Case 2, that cystic area didn’t seem to be along the plane of friction so I don’t know if it was actually “bursitis”.

Thanks!

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[Stephen Bird]

Interesting cases Diane.

The way I think about fluid in the trohanteric bursa is not surprisingly similar to how I think about fluid in the subacromial sub deltoid bursa. In both joints when I see thickening of the bursa which represents synovial proliferation I think of bursitis. When I see frank fluid I am on the hunt for a tear. The only difference is the gluteus minimus and medius tendons are not only like to fail at the enthesis like supraspinatus, but also like to fail at their MTJ.

In your first case I am not actually convinced it is fluid and would like to suggest the possibility that it is some fat in the plane between G-Max and the deep lateral rotators of the hip. I think this due to the texture of the area and also the way it moves on dynamic assessment.
I may well be wrong but that is my first impression.

The second are looks like significant synovial proliferation and I would simply call this a good case of bursitis. I a happy it is in the right plane. There may be a trace of fluid but I think it is mainly synovial proliferation.

The manoeuvre doesn’t have a particular name as far as I know, but I call it a “reverse clam” as with a clam you keep the ankles together and seperate the knees and this is the opposite to that !

Steve

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