Find a spe­cial­ist for trochanteric bur­si­tis Keith Roach

Cape Breton Post - - HEALTH / ADVICE - Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health news­let­ters at P.O. B

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.

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