Find a specialist for trochanteric bursitis Keith Roach
DEAR DR. ROACH: I am a 78year old woman with longstanding trochanteric bursitis. I am always offered cortisone injections, and most of them have not worked. When they did, they were short-lasting. This bursitis can be severe. In the beginning I was given high doses of anti-inflammatories, but these gave me ulcers, so I can never take them again. I do everything I know to keep the pain at bay. I am wondering if you know of any new remedies for my condition. I am unable to find a physician who specializes in this type of bursitis. I am just told that it falls under the scope of orthopedics, so the physicians I have seen know only about the above remedies to help me.
What is your opinion of surgically removing the bursa, as one physician suggested? — B.C.
ANSWER: Trochanteric bursitis is inflammation of the bursa (I think of these as "oil patches" under the skin — small, lubricating sacs that help tissues move smoothly over each other) that is directly over the "point" of the hip — the greater trochanter. This inflammation causes a sharp pain and tenderness in the region of the outer thigh.
Steroid injections usually are effective. When they are not, I worry that the diagnosis is incorrect. Several conditions can masquerade as trochanteric bursitis, including a gluteus medius tendon tear, stress fracture or hidden fracture of the hip. Many conditions that cause the bursitis to begin with, including lower-spine arthritis, discrepancy in the length of the two legs and inflammation of the sacro- iliac joint all can cause the bursitis to come back after treatment if they aren’t properly treated.
Another issue that can keep the injection from working is not taking proper care of the hip after the injection, and I worry that you might not have gotten careful instructions. Rest after the injection helps keep the medication where it belongs; excess activity forces the medicine out, and occasionally bed rest is necessary for up to three days for severe cases. Ice also can relieve inflammation, so I recommend using it for 15 minutes every few hours in the few days after the injection.
Orthopedic surgeons often have areas of subspecialization, and I would seek out the most experienced orthopedic surgeon who specializes in the hip that you can find. Surgical removal of the bursa is rarely done (I’ve never seen it), but even if it is, the bursa can reform after surgery.
DEAR DR. ROACH: Regarding the recent column on a man with bladder stones after treatment for prostate cancer, bladder stones have their own pathophysiology and are unrelated to stones coming down from the kidney. The No. 1 reason for bladder stones is incomplete bladder emptying. The stasis of urine leads to infection, and the stones most often are calcium phosphate or magnesium ammonium phosphate. The patient had lots of reasons to empty incompletely and have urine infection. Radiation therapy, be it seeds or external beam, strips the protective lining of the bladder and promotes urine infection. Though the prostate cancer was treated, he still can have bladder outlet problems, with strictures from the radiation impeding emptying. The gland itself can still be obstructive.
His bladder stones are going to persist as long as the fundamental problem exists. His urologist is not helping him. He needs another urologist to get the underlying problem taken care of. — Dr. George Steinhardt
ANSWER: Thank you for the helpful information. A surgeon often has a perspective that I, as an internist, lack.
READERS: The booklet on diverticulitis explains this common disorder and its treatments. Readers can order a copy by writing: Dr. Roach — No. 502, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$5 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.