Trochanteric Pain
A real pain in the leg..."it must be Sciatica"...or is it..?
I once had a gentleman present in consult convinced he had "sciatica".
When I asked him which leg, he looked at me, bemused at the presumption, and replied, "the sciatica is in my arm".
When you see hundreds of patients a month, many of whom have read around their symptoms on the web, it is easy to forget that some don't have even a very basic anatomy knowledge.
In essence he was describing nerve pain. After explaining that one only has a sciatic nerves in each leg, unless you are wired up in a very strange way, we proceeded with the consult.
I share this anecdote because it made me smile but on a more significant note, shows how easy it is to jump to inaccurate diagnosis. This doesn't just happen with self diagnosis but sadly with scanty diagnosis all too frequently applied by medical professionals.
Trochanteric pain syndrome is often favoured as a diagnosis/label for bursitis around the hip as there is no clinical, laboratory or imaging evidence demonstrating inflammation of the bursa in a high percentage of cases that present in clinic but it still elicits symptoms in the same way.
Frustratingly, it is a condition that is frequently misdiagnosed by trained medical practitioners of all disciplines, partly due to the number of co-related conditions which fall under the same banner. It gives pain, similar to mild sciatica but down the side of the thigh and lower leg as opposed to the back of the leg. Technically this is still a nerve problem but as it runs through completely different structures, treating it as you would sciatica would be fairly fruitless.
I have lost track of the number of people I have treated with this condition who have been incorrectly diagnosed because they weren't properly examined by whoever gave the diagnosis.
Sometimes it is easy to spot people who may be predisposed just from their pelvic width, leg length discrepancy and associated lower back and sacroiliac issues. It can affect anyone but the classic sufferer is more likely to be an overweight female in her 40s to 60s.
Diagnosis of most mechanical pain is rarely 'text book'. I saw a patient recently seen by his doctor who had told him there was no way he had bursitis as it "wasn't tender enough" over the greater trochanter (side of the hip bone) when the practitioner picked his leg off the couch. In a full blown acute trochanteric bursitis I would completely agree but on a properly detailed examination the patient revealed four out of the five key areas involved in trochanteric pain syndrome including, for those interested in the more detailed anatomy, subgluteus maximus and minimus bursae involvement, moderate gluteal tendinitis and a positive flexion adduction sign with TFL tenderness on palpation and marked sacroiliac torsion. I apologise if I've lost you a little at this point, there isn't the room here to expand on the anatomy but Google it if you want to know more.
Caught at any stage, trochanteric pain syndrome is treatable but muscle memory and the ability to alter it quickly therapeutically, is inversely proportional to the duration of symptoms.
For recalcitrant symptoms injection therapy maybe useful as chronic inflammation can lead to new bursae forming (adventitious bursae) and / or calcification of the soft tissues, a condition known as myositis ossificans. Osteopaths are fully trained to pick up on this and will arrange for an MRI referral privately or via your GP as necessary.
Moral of this editorial; get pain checked out by sooner rather than later by someone who is trained in musculoskeletal diagnosis.
NICE guidelines from studies recommend that manipulation as practised by osteopaths is effective in treating pain of between six weeks duration and less than one year.
Are you still putting up with pain? Call our friendly team of Osteopaths at Sandbach Osteopathic and Sports Injury Clinic 01270 759491 or book online and let us help you get pain free.
I once had a gentleman present in consult convinced he had "sciatica".
When I asked him which leg, he looked at me, bemused at the presumption, and replied, "the sciatica is in my arm".
When you see hundreds of patients a month, many of whom have read around their symptoms on the web, it is easy to forget that some don't have even a very basic anatomy knowledge.
In essence he was describing nerve pain. After explaining that one only has a sciatic nerves in each leg, unless you are wired up in a very strange way, we proceeded with the consult.
I share this anecdote because it made me smile but on a more significant note, shows how easy it is to jump to inaccurate diagnosis. This doesn't just happen with self diagnosis but sadly with scanty diagnosis all too frequently applied by medical professionals.
Trochanteric pain syndrome is often favoured as a diagnosis/label for bursitis around the hip as there is no clinical, laboratory or imaging evidence demonstrating inflammation of the bursa in a high percentage of cases that present in clinic but it still elicits symptoms in the same way.
Frustratingly, it is a condition that is frequently misdiagnosed by trained medical practitioners of all disciplines, partly due to the number of co-related conditions which fall under the same banner. It gives pain, similar to mild sciatica but down the side of the thigh and lower leg as opposed to the back of the leg. Technically this is still a nerve problem but as it runs through completely different structures, treating it as you would sciatica would be fairly fruitless.
I have lost track of the number of people I have treated with this condition who have been incorrectly diagnosed because they weren't properly examined by whoever gave the diagnosis.
Sometimes it is easy to spot people who may be predisposed just from their pelvic width, leg length discrepancy and associated lower back and sacroiliac issues. It can affect anyone but the classic sufferer is more likely to be an overweight female in her 40s to 60s.
Diagnosis of most mechanical pain is rarely 'text book'. I saw a patient recently seen by his doctor who had told him there was no way he had bursitis as it "wasn't tender enough" over the greater trochanter (side of the hip bone) when the practitioner picked his leg off the couch. In a full blown acute trochanteric bursitis I would completely agree but on a properly detailed examination the patient revealed four out of the five key areas involved in trochanteric pain syndrome including, for those interested in the more detailed anatomy, subgluteus maximus and minimus bursae involvement, moderate gluteal tendinitis and a positive flexion adduction sign with TFL tenderness on palpation and marked sacroiliac torsion. I apologise if I've lost you a little at this point, there isn't the room here to expand on the anatomy but Google it if you want to know more.
Caught at any stage, trochanteric pain syndrome is treatable but muscle memory and the ability to alter it quickly therapeutically, is inversely proportional to the duration of symptoms.
For recalcitrant symptoms injection therapy maybe useful as chronic inflammation can lead to new bursae forming (adventitious bursae) and / or calcification of the soft tissues, a condition known as myositis ossificans. Osteopaths are fully trained to pick up on this and will arrange for an MRI referral privately or via your GP as necessary.
Moral of this editorial; get pain checked out by sooner rather than later by someone who is trained in musculoskeletal diagnosis.
NICE guidelines from studies recommend that manipulation as practised by osteopaths is effective in treating pain of between six weeks duration and less than one year.
Are you still putting up with pain? Call our friendly team of Osteopaths at Sandbach Osteopathic and Sports Injury Clinic 01270 759491 or book online and let us help you get pain free.
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