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Hip bursitis

Before learning about hip bursitis, it is helpful to know about what a bursa is. A bursa is a thin sac filled with fluid. The purpose of a healthy bursa is to reduce friction between bone and soft tissue, such as skin, muscles, ligaments and tendons. Hip Bursitis is when the bursa becomes irritated, inflamed, and causes the bursa to swell.
Hip bursitis

Causes of Hip Bursitis

Hip Bursitis can be caused by various factors, including:

Degenerative Changes: As we age, the bursae lose water content and elasticity, becoming more prone to developing bone spurs or calcium deposits that can grow and harden over time.

Repetitive Friction: Repetitive mini-traumas to the bursa, like biking, running, or climbing stairs, can cause inflammation.

Trauma: Previous hip injuries or accidents can cause the bursa to fill with blood and become inflamed.

Medical Conditions: People who are predisposed to joint pain with rheumatoid arthritis or gout are at higher risk to develop hip bursitis.

Bacterial Infection: An infection of the hip bursa is called septic bursitis. People with diabetes, alcoholism, COPD, gout, or rheumatoid arthritis are at higher risk.

Symptoms of Hip Bursitis

The most common symptom of hip bursitis is hip pain. The symptoms may gradually develop and worsen over time. The hip pain may be sharp and shooting or a dull ache. The hip pain is felt at the outside of the hip, where the upper thigh curves out. Other symptoms include:

  • Hip tenderness
  • Radiating pain down the thigh, lower back, butt, or groin
  • Pain that is worse with repetitive activity
  • Pain that is worse after prolonged inactivity
  • Pain at extreme range of motion

Impact of Hip Bursitis

Hip bursitis can lead to several conditions:

  • Weakened hip muscles: Also known as atrophy, chronic bursitis can lead to weakened muscles due to decreased use.
  • Gluteus medius tear: Bursa inflammation could puts extra pressure on the gluteus medius muscle (in the butt) and can cause weakening and tearing.

Diagnosis of Hip Bursitis

To diagnose hip bursitis, a doctor will have to rule out other problems that could cause outer hip pain like hip osteoarthritis, tendonitis, and iliotibial band syndrome. Diagnosing hip bursitis typically involves:

Medical History: Discussion of symptoms, past medical conditions, and any history of hip injuries.

Physical Examination: Assessment of reflexes, muscle strength, swelling, tenderness, pain points and sensation.

Diagnostic Imaging: X-rays to assess for fracture or osteoarthritis, CT scans or MRI scans to visualize soft tissue like a swollen bursa or damaged tendon.

Treatment of Hip Bursitis

Treatment options include:

Conservative Treatments: Non-surgical approaches include:

Rest and Activity Modification: Avoid activities that aggravate and inflame the bursa, which includes sports and/or standing for long periods of time.

Medications: Such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or topical anti-inflammatory medications for pain management.

Physical Therapy: Exercises to strengthen leg and butt muscles.

Steroid Injections: Targeted injections to reduce inflammation and alleviate pain.

Acupuncture or Chiropractic Care: Some patients find relief through alternative therapies.

Surgical Intervention: When conservative measures are ineffective or symptoms worsen, surgery
    may be considered:

Bursectomy: Removing the affected bursa.

Tendon Repair: Repairing an injured tendon can reduce unwanted friction and relieve bursa pain.

Osteotomy: Shaving off part of the hip bone can reduce the friction and stress on the bursa causing the hip pain.

Prognosis: Hip bursitis usually resolved after a few weeks to months or rest and activity modification. However, there is a high chance of recurrence with repetitive movement. For some, the pain does not resolve and more treatment is needed such as steroid injections or surgery.

Procedure Videos

Steroid Injection

References:

https://www.arthritis-health.com/types/bursitis/hip-bursitis-treatment

https://my.clevelandclinic.org/health/diseases/4964-trochanteric-bursitis

https://orthoinfo.aaos.org/en/diseases–conditions/hip-bursitis/

Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. 2011 Sep;21(5):447-53. doi: 10.1097/JSM.0b013e318221299c. PMID: 21814140; PMCID: PMC3689218.