What is the first-line management for trochanteric bursitis?

• A. Physical therapy, NSAIDs, steroid injections, and cold therapy
• B. Broad-spectrum antibiotics
• C. Surgical excision of the bursa
• D. Physical therapy, NSAIDs, steroid injections, and symptomatic relief with ice or heat

Answer: (D)

Trochanteric bursitis is managed best with nonoperative steps that calm inflammation and restore hip mechanics. The most effective first-line plan combines physical therapy and anti-inflammatory medicine to reduce pain and friction at the greater trochanter while rebuilding strength and flexibility. Targeted physical therapy helps by strengthening the hip abductors, especially the gluteus medius, and improving iliotibial band flexibility, which lowers pressure on the bursa during movement. NSAIDs address inflammation and pain, making it easier to participate in rehab. Using ice or heat provides additional symptomatic relief during flare-ups. Corticosteroid injection is included when symptoms persist despite these measures or when rapid relief is needed to continue rehabilitation, making it a common part of initial conservative management in many practice patterns. Antibiotics aren’t indicated unless there’s suspicion of infection, and surgery is reserved for refractory cases after exhausting nonoperative options.