63 year old male from Mexico flew in today for evaluation and treatment of left hip, patient states 6 months ago he fell down, since then he has pain in the hip 24 hours a day. Pain interferes with his activities specially his golf game. Pain gets worse when he walks too much or lies down or roll over on the hip, the aching pain sometimes radiate down the outside of the thigh as far as the knee. Climbing the stairs, has been so painful that patient had to build an elevator for his house. Patient's past medical history is otherwise complicated by Open heart surgery and aortic valve replacement, for which patient needs to be on Coumadin for life. His pain responds to Advil somewhat. On exam his range of motion is normal however he has excruciating pain and tenderness upon palpation of the hip, tenderness is mostly focused on the outside of the upper thigh, just over the point of the hip.
Discussion: This area is known as greater trochanter (tro-KAN-ter). A bursae is small sac, filled with a little fluid, that cushions between bones, tendons and muscles. Several bursaes are located around the outer area of the hip, this area can get inflamed easily producing chronic pain and discomfort. The inflammation is generally caused by trauma and repetitive motion however other causes such as Leg-length discrepancies as well as scoliosis of spine could produce this entity. X-Rays and MRIs are usually negative but the physical exam will give clues for diagnosis. If conservative therapy such as rest, ice, or anti-inflammatory meds fails your physician may recommend injection.