When you are assessing a runner with a diagnosis of Trochanteric Bursitis, what do you look at first to rule out other players?
Answer
That is a great question. This is one of the most common things that you will see. The part that makes me suspicious that it is Trochanteric Bursitis is their age. Not exclusively, but as they are getting closer to middle age, it is more common for there to be some chronic glut tendinopathy. I will ask them about changes within their training regimen. If I am getting from them that it is more of a chronic presentation, it makes me more suspicious about it. From an examination standpoint, very much it is going to be about my palpation. If it is true bursitis, it is very often going to be very diffuse pain in and around the entire region around the greater troch. If it is more often glut med pathology, the palpation findings are more localized and more specific. While they may be uncomfortable in a number of areas, you are going to find more exquisite pain at that insertion point, at the enthesis with Trochanteric Bursitis. You may also feel some changes in density in the tissue. Also look at some of the factors that are going to overload the region. Again look for weakness and pain on manual muscle test. Oftentimes, I will see people that have concomitant tightness of their hip flexors. When I am considering the glut med and glut min, I see those a whole lot more with women than I do with men.
David Nolan, PT, DPT, MS, OCS, SCS, CSCS
Dr. Nolan is an Associate Clinical Professor at Northeastern University in the Department of Physical Therapy, Movement and Rehabilitation Sciences as well as a Graduate Lecturer in the College of Professional Studies in the transitional Doctor of Physical Therapy Program at Northeastern University. He is also a Lecturer at Harvard Medical School in the Physical Medicine and Rehabilitation. David is also a Clinical Specialist at the Mass General Sports Physical Therapy Service and the Director of the MGH / Northeastern University Sports Physical Therapy Residency Program.
David is a board certified Orthopedic Clinical Specialist and Sports Clinical Specialist through the American Board of Physical Therapy Specialties and a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association. In 2019, Dr. Nolan was the recipient of the Lynn Wallace Clinical Educator Award from the American Academy of Sports Physical Therapy. He is a past recipient of the “Excellence in Clinical Teaching” award from the New England Consortium of Academic Coordinators of Clinical Education as well as the award for Outstanding Achievement in Clinical Practice by the Massachusetts Chapter of the APTA. In 2022, Dr. Nolan received the Richard Kessler Memorial Award from the APTA of Massachusetts. Dr. Nolan was also honored with the APTA Academy of Physical Therapy Education's Distinguished Mentor in Residency/Fellowship Education Award in the same year.
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