Review Question - QID 216489

This patient who presents with lateral hip pain over the greater trochanter that is worse when sitting in a chair most likely has trochanteric bursitis. Non-infected bursitis is best treated with non-steroidal anti-inflammatory drugs such as ibuprofen.

Bursae are fluid-filled spaces lined by a synovial membrane. Normally, these structures facilitate motion by padding areas of contact; however, they can become inflamed when compressed or irritated resulting in bursitis. Bursitis presents with localized tenderness to palpation at the site of the bursa without any signs of inflammation such as warmth, erythema, or induration. Common examples include pre-patellar bursitis, olecranon bursitis, pes anserine bursitis, and trochanteric bursitis. As long as no signs of infection such as fever or inflammation are present, simple non-infectious bursitis can be treated with rest and non-steroidal anti-inflammatory drugs.

Weber et al. discuss potential etiologies of pain near the greater trochanter. These include trochanteric bursitis, gluteus medius or minimus tendinopathy, and disorders of the proximal iliotibial band.

Figure A is an anteroposterior radiograph of the right hip. The joint appears completely normal with no signs of infection or osteoarthritis.

Incorrect Answers:
Answer 1: Aspiration may sometimes be performed when there is a high suspicion for bursal infection, though a more common treatment is systemic antibiotic therapy. While the regional distribution of pain would be similar for this condition, infection will also present with inflammatory signs such as erythema, induration, warmth, swelling, or crepitus.

Answer 2: Cephalexin can be used empirically when there is a high suspicion for skin or soft tissue infections such as cellulitis. Infections would present with erythema, rash, and drainage of the affected area.

Answer 3: Drainage should be performed if infection of bursal fluid is confirmed or if grossly purulent fluid is found in the space. It would not be performed for a non-infected bursitis.

Answer 5: Surgery can be performed for osteoarthritis of the hip refractory to initial treatments. In this patient, there is no evidence of osteoarthritic changes such as sclerosis, subchondral cysts, or osteophyte formation.

Bullet Summary:
Non-infectious bursitis presents with localized tenderness to palpation and can be treated with rest, padding, and non-steroidal anti-inflammatory drugs.