September 2010 -- Hip Bursitis/Trochanteric Bursitis
Description
Bursitis is caused by inflammation of a bursa, a small jelly-like sac that usually contains a small amount of fluid. Bursae are located throughout the body, most importantly around the shoulder, elbow, hip,
knee, and heel. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.
Another bursa located on the inside (groin side) of the hip is called the iliopsoas bursa. When this bursa becomes inflamed, the condition is also sometimes referred to as hip bursitis, but the pain is located in the groin area. This condition is not as common as trochanteric bursitis, but is treated in a similar manner.
How Does it Occur?
The trochanteric bursa may be inflamed by a group of muscles or tendons rubbing over the bursa and causing friction against the thigh bone. This injury can occur with running, walking, or bicycling, especially when the bicycle seat is too high.
Symptoms
The main symptom of hip bursitis is pain at the point of the hip. The pain usually extends to the outside of the thigh area. In the early stages, the pain is usually described as sharp and intense. Later, it may feel more achy and spread out.
Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while. It also may get worse with prolonged walking, stair climbing, or squatting
Risk Factors
Hip bursitis can affect anyone, but is more common in women and middle-aged or elderly people. It is less common in younger people and in men.
The following risk factors have been associated with the development of hip bursitis.
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Repetitive stress (overuse) injury. This can occur when running, stair climbing, bicycling, or standing for long periods of time.
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Hip injury. An injury to the point of your hip can occur when you fall onto your hip, bump your hip on the edge of a table, or lie on one side of your body for an extended period of time.
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Spine disease. This includes scoliosis, arthritis of the lumbar (lower) spine, and other spine problems.
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Leg-length inequality. When one leg is shorter than the other by more than an inch or so, it affects the way you walk and can lead to irritation of a hip bursa.
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Rheumatoid arthritis. This makes the bursae more likely to become inflamed.
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Previous surgery. Surgery around the hip or prosthetic implants in the hip can irritate bursae and cause bursitis.
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Bone spurs or calcium deposits. These can develop within the tendons that attach to the trochanter. They can irritate the bursa and cause inflammation.
Diagnosis
To diagnosis hip bursitis, the doctor will perform a comprehensive physical examination, looking for tenderness in the area of the point of the hip. He or she may also perform additional tests to rule out other possible injuries or conditions. These tests can include radiography (x-rays), bone scanning, and magnetic resonance imaging (MRI).
Treatment
The initial treatment for hip bursitis does not involve surgery. Many people with hip bursitis can experience relief with simple lifestyle changes, including:
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Modification of activities—avoiding the activities that worsen symptoms
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Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, piroxicam, celecoxib, and others, to control inflammation and pain
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Using ice packs 20-30 minutes every 3 to 4 hours
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Use of a walking cane or crutches for a week or more when needed
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Physical Therapy
A physical therapist will teach you how to stretch your hip muscles and use other treatments such as ice, heat, or ultrasound.
Injection of a corticosteroid along with a local anesthetic may also be helpful in relieving symptoms of hip bursitis. This is a simple and effective treatment that can be done in the doctor's office. It involves a single injection into the bursa. The injection typically provides permanent relief. If pain and inflammation return, another injection or two, given a few months apart, may be needed.
Use NSAIDs cautiously and for limited periods. Talk with your doctor about the NSAIDs you use. NSAIDs may have adverse side effects if you have certain medical conditions or take certain medications.
Prevention
Prevention is aimed at avoiding behaviors and activities that make the inflammation of the bursa worse.
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Avoid repetitive activities that put stress on the hips.
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Lose weight if you need to.
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Get a properly fitting shoe insert for leg-length differences.
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Maintain strength and flexibility of the hip muscles.
When Can I Return to Activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Retrun to your sport or activity will be determined by how soon your leg recovers, not by how many days or weeks it has been since your injury occured. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. You may safely return to your sport or activity when,
- you have full range of motion and strength in the injured leg compared to the uninjured leg.
Copyright ©1995-2010 by the American Academy of Orthopaedic Surgeons.
