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Trancanteric Pain

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Trancanteric Pain Symptoms
This is a relatively common condition that can cause significant pain on the outer aspect of the hip. It tends to be constant, often tender to touch and its intensity can vary over time.

Who does this affect?
The majority of patients are female, often in their forties or older. They may or may not have had surgery in the past and the true cause of the condition is unclear. It may be caused by a combination of tight fascia lata, inflammed trochanteric bursa (figure 1) and tendon tears. Occasionally, the lateral hip pain is secondary to a deeper hip joint problem such as hip impingement.

Investigations
X-rays of the hip are usually normal. Scans such as magnetic resonance scans can be useful to confirm the diagnosis as well as out-ruling any other pathology (figure 2).

Non-surgical Treatment
Physiotherapy (particularly working on core-stability and fascia lata stretching exercises), painkillers, anti-inflammatory drugs and localised high frequency ultrasound can all be useful. Podiatry and in-soles can correct foot position and relieve symptoms. Steroid injections into the area of maximal tenderness will usually make a significant difference but how long it lasts can vary from patient to patient. Professor Fehily would generally carry out between 2 or 3 injections before considering surgery.

Investigations
X-rays of the hip are usually normal. Scans such as magnetic resonance or ultrasound scans can be useful to confirm the diagnosis as well as out-ruling any other pathology (figure 2).

Non-surgical Treatment
Physiotherapy (particularly working on core-stability and fascia lata stretching exercises), painkillers, anti-inflammatory drugs and localised high frequency ultrasound can all be useful. Steroid injections into the area of maximal tenderness will usually make a significant difference (but how long it lasts can vary from patient to patient) and can make physiotherapy easier to carry out. Professor Fehily would generally carry out between 1 or 2 injections before considering surgery.

Surgical Treatment
If patients symptoms do not settle with conservative therapy, then surgery is recommended. Professor Fehilys’ procedure of choice is to do an open fascia lata release, plus a bursa excision or tendon repair if required. The options are best discussed at the time of your consultation. While this can be of great benefit to the patient, not all patients are cured. Roughly speaking, a third are cured, a third are better and a third have no benefit from surgery.

The Manchester Hip Clinic is committed to helping all kinds of people with hip problems to be free from pain and often to resume near-normal levels of physical activity – even those who may have thought that such relief would never be possible.

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