Background Trochanteric bursitis (Tb) is one of the most common soft tissue abnormalities in the hip region. Tb is common; affecting 10-25% of the population.
Power Doppler (PD) ultrasonography (US) is a sensitive method for demonstrating the presence of blood flow in small vessels. PD US enables visualization of synovial hyperemia. High frequency and PD US in combination are sensitive and reproducible tools for determining joint effusions and synovitis. The term Tb may be a misnomer given that three of the cardinal symptoms of inflammation: warmth, erythema and swelling are rarely seen in these patients. Could use of US help us better understand Tb?
Objectives To identify how commonly US and PD US changes suggestive of Trochanteric bursa inflammation are seen in patients with the clinical syndrome of Tb.
Methods This study was a retrospective chart and US image review of patients seen in the Rheumatology clinic between 12/1/2006 and 2/1/2010 with a primary or secondary diagnosis of trochanteric bursitis (diagnosis codes CPT 76942 and/or 20610). Trochanteric bursa US images were reviewed for signs of inflammation (bursa swelling and capsule thickening), as well as PD US signals. Recorded were patients’ past medical history and medications at the time of diagnosis and the response to intrabursal corticosteroid injections given by a Rheumatologist (AB,NS).
Results 287 patient charts with CPT 76942 and 20610 were reviewed. Seventy five patients were found to have a diagnosis of Tb. Of these 75 patients; 52 underwent trochanteric bursa injections and had US images. 13 patients had bilateral trochanteric bursa images; 4 patients had the same bursa examined more than once. Total number of US images n=67, total number of PD US n=51.
The average age of the patients was 49 (range:24-76) years. 50 (99%) patients were female; only two (1%) patients were male. Most patients had underlying osteoarthritis (OA) n=23 (44%) and Fibromyalgia syndrome (FM) n=26 (50%). Five (9.6%) patients with Tb had Sjogren’s Syndome. 31 (60%) patients diagnosed with Tb were on NSAIDs at the time of the diagnosis and 12 (23%) on a neuropathic pain medication.
The Rt trochanteric bursa was most commonly involved (n=44 (66%)). All (n=51 (100%)) of PD US were Grade 0 (normal: no evidence of inflammation). Only 2 of 67 (<1%) trochanteric bursa US images showed an effusion. None had bursal wall thickening. Pain relief was seen for an average of 4.5 months post-injection in 26 (50%) patients who had a follow up visit.
Conclusions This is the first study to date examining the use of US and PD US as a means to review inflammation in patients with Tb. We found that patients with clinical Tb do not have US evidence to support a diagnosis of bursal inflammation. We suspect the right trochanteric bursa was commonly involved since this was the dominant side in most patients. The involvement of mostly females is not surprising since females suffer more commonly from soft tissue rheumatism than men. Since we did not find signs of inflammation in the trochanteric bursa, we suggest that the most appropriate term to be used for what was previously known as trochanteric bursitis is Trochanteric Pain Syndrome.
Disclosure of Interest None Declared
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