Initially, I prefer to use physiotherapy. This will need to be adapted to each type of tendonitis. The hip joint should be rested, and any sporting activity involving the hip joint should be discontinued. Physiotherapy sessions should be accompanied by physiotherapy (ionization, shock waves, electrotherapy, etc.). The use of ice is still recommended.
Subsequently, infiltrations with various products can be considered. Appropriate "cocktails" with several products give good results.
If pain persists despite medical treatment, surgery may be considered.
This tendonitis essentially presents as pain on the outer side of the buttock and slightly posterior to it. The pain is exacerbated by stair climbing, especially the first few steps and after prolonged sitting.
True overuse tendonitis of this muscle is fairly rare, and occurs in people who do a lot of walking or sports, or in people who walk poorly (limping) after pelvic problems (osteoarthritis, total hip replacement, unequal limbs).
Diagnosis is most often clinical and confirmed by palpation of the tendon at rest or during contraction of this muscle. An additional work-up is sometimes necessary to confirm the diagnosis (ultrasound, MRI, hip scintigraphy) or to differentiate with other pathologies (coxarthrosis, joint conflit, lumbosciatica, tendon rupture, osteitis...).
This tendon attaches to the iliac crest and tensions the fascia on the outside of the thigh. This long tendon attaches to the anterolateral surface of the tibia. The tendon passes over two bony predominances at hip level (the greater trochanter) and at knee level (the lateral femoral condyle).
In the knee, it's a syndrome known as the ice-wiper syndrome, and is most often seen in runners.
At hip level, it's more a case of a pop or snapping sensation perceived outside the joint. These snaps are sometimes audible and perceptible during flexion extension of the hip, and correspond to the passage of this tendinous band over the bony surface of the greater trochanter. It is mostly felt during active hip mobilization; diagnosis is mainly clinical, but dynamic ultrasound can highlight the tendinous passage above the trochanter.
On the outer surface of the hip, the bony relief is lined by a small fluid-filled sac that acts as a sliding surface. Its function is to prevent friction between bone (in this case, the outer surface of the proximal femur, the trochanter) and soft tissue (in this case, the tendon of the gluteus maximus muscle). Occasionally, this serous bursitis can enflammer and give rise to what is known as bursitis. On the hip, the most common form is per trochanteric bursitis.
It often results in painful tenderness on the outer side of the hip, and patients find it difficult to sleep on the affected side. This pain is aggravated by excessive walking, and climbing stairs is done with difficulty. Sometimes this pain can appear after prolonged sitting. Complementary examinations are required to support this diagnosis (ultrasound, MRI, hip scintigraphy). Thus, before making the diagnosis of per trochanteric bursitis, we must exclude pain of other origins: coxarthrosis, necrosis of the femoral head, tendonitis...
The psoas muscle is a muscle that performs the flexion of the hip on the abdomen whose insertion is located on the medial aspect of the thigh opposite the inguinal crease.
This tendonitis is particularly common in athletes who effect repetitive movements such as kicking, running and jumping. It's a sign of tendon overuse.
Tendonitis-type injuries have already been described in a number of sports, including soccer, rugby, swimming, running, long jump and high jump...
This tendinitis may also be due to conflit with the anterior edge of the hip prosthesis in patients with a total prosthesis. The patient complains of pain on the medial side of the hip, increased by flexion of the hip. Pain is also felt when testing elevation of the outstretched leg in slight external rotation from thirty degrees.
Diagnosis is confirmed by complementary examinations such as ultrasound, MRI or scintigraphy. At the time of diagnosis, pain of other origins must be excluded: coxarthrosis, tendon rupture, abductor tendinitis, pubalgia, abductor lesion, etc.
More often than not, the area is painful and warmer. Joint mobilization awakens pain in the affected tendon, which is moderately relieved by rest.
Specific power-up tests are carried out in consultation.
Let's take a look at some of the tendonitis often encountered in the hip area.
The hip joint is surrounded by muscles that attach themselves to the joint. The gluteus medius muscle, the tensor fascia lata (TFL), the couturier muscle and the rectus femoris attach to the iliac bone, while the psoas muscle originates from the spinal column and attaches distally to the femur bone.
Tendonitis is the inflammation of a tendon, most often caused by repetitive or excessive strain on the tendon.