One of the more common reasons patients are referred to me is for the treatment of hip bursitis. They come to me following a diagnosis of Greater Trochanteric Bursitis and a treatment recommendation for corticosteroids injections. These patients experience pain over the side of their hip, which is made worse with walking or getting up from a chair. The pain also prevents them from sleeping on that side.
However, during the physical examination I seldom find bursal swelling as you would expect from a true bursitis. Even an ultrasound examination will fail to find bursal fluid in most cases. What I do find is tenderness to palpation over the greater trochanter, where the gluteal tendons insert onto the bone. Patients also often demonstrate weak gluteal muscles.
My working diagnosis at that point becomes gluteal tendon injury rather than a hip bursitis. When a patient has sufficient symptoms of weakness or pain, I check a pelvic MRI which will often reveal the suspected gluteal injury as tendinitis, tendinosis, or tendon tear. Generally, the gluteus medius tendon is the injured party.
These tears are generally found in several clinical situations. Most commonly, these tears are found in patients with no direct hip injury or gluteal muscle trauma. These are called chronic non- traumatic tears. In my experience, most of these patients have a significant spine history, meaning they have suffered from low back pain, with or without pain radiating to their leg, or have undergone spine surgery. What is happening In these situations, one or more of the lower lumbar nerves, which provide the nerve supply to the gluteal muscles, are not working at 100% due to compression in the lumbar spine. The result is a poorly functional, weakened gluteal muscle which is not able to stabilize the hip joint as it is intended. This leads to excessive wear on the tendon attaching to bone, causing tendinitis (tendinosis if present for a long time) and sometimes, tendon tears.
A third situation in which gluteal tendon tears are found during a hip replacement surgery. In this scenario the tendon injury is often a result of having weakened gluteal tendons, which allows excessive movement in the hip joint. Too much movement in a joint promotes joint degeneration, which leads to the need for hip replacement surgery. In this case, the tendon injury preceded and promoted the hip degeneration (arthritis), rather than the arthritis causing a gluteal tendon injury.
Regardless of the cause, gluteal tendon injuries are not best treated with corticosteroid injections, as is traditionally recommended, since steroids are well known to damage tendons. An effective alternative is an injection of super concentrated platelets. Platelet-rich plasma (PRP) therapy is non-invasive and uses your body’s own platelets to create a naturally healing process. In fact, a high-level study published in 2018 in the American Journal of Sports Medicine, showed that patients with chronic gluteal tendon injury achieved greater improvement in symptoms with one PRP injection to the tendon than those who underwent a steroid injection.
To learn more about PRP Therapy and to find out how it can help treat lateral hip pain, call Advanced PainCare today to schedule your evaluation.