What is Hip Bursitis?
A "bursa" is a small jelly-like sac usually containing a small amount of fluid. Bursae are located throughout the body. The most important bursae are located around the shoulder, elbow, hip, knee and heel. A bursa functions as a cushion between bones and the overlying soft tissues. It helps reduce friction between the gliding muscles and the bone.
The point of the hip is called the greater trochanter. It functions as an attachment point for several important muscles that move the hip joint. The trochanter has a fairly large bursa overlying it. The bursa measures about 3 inches long, 2 inches wide, and 1/4 inch thick. This bursa occasionally becomes irritated or inflamed. This is a common cause of hip pain. When this occurs, the condition is called "hip bursitis" or "trochanteric bursitis." Another bursa located on the inside (groin side) of the hip is called the iliopsoas bursa. When it becomes inflamed, the condition is also sometimes referred to as hip bursitis, but the pain is located in the groin area. It is treated in a similar manner as trochanteric bursitis, but is less common.
Diagnostic Tests to Confirm Hip Bursitis:
- Physical Examination: Physician looks for tenderness in the area of the point of the hip
- Bone Scan
- MRI of the Hip area
Risk Factors to getting Hip Bursitis:
Trochanteric bursitis can affect anyone at any age. It is more common in women and in middle-aged or elderly people. It is less common in younger people and in men. The following circumstances have been associated with the development of hip bursitis:
- Repetitive stress (overuse) injuries: These can include running, stair climbing, bicycling or standing for long stretches of time.
- Injury to the point of the hip: This can include falling onto the hip, bumping your hip on the edge of a table, lying on one side of the body for an extended period, etc.
- Spine disease: This can include scoliosis, arthritis of the lumbar (lower) spine and other spine problems.
- Leg-length inequalities: When one leg is shorter than the other by more than an inch or so, this affects the way you walk and can irritate the bursa.
- Rheumatoid arthritis: This makes the bursae more likely to become inflamed.
- Previous surgery around the hip or prosthetic implants in the hip
- Hip bone spurs or calcium deposits in the tendons which attach to the trochanter
Trochanteric bursitis can happen even when you don't have any of these conditions.
Symptoms of Hip Bursitis:
- The main symptom is pain at the point of the hip.
- Pain usually extends to the outside of the thigh area and is usually described as sharp and intense in the early stages of the problem
- With time, the pain feels more "achy" and spread out.
- Pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while.
- Hip pain is worse with prolonged walking, stair climbing or squatting.
Prevention is aimed at avoiding behaviors and activities that make the inflammation of the bursa worse. Some tips:
- Avoid repetitive activities that put stress on the hips.
- Lose weight if you need to.
- Get a properly fitting shoe insert for leg length differences.
- Maintain strength and flexibility of the hip muscles.
- Treatment Options of Hip Bursitis: Non-Surgical
- The initial treatment for hip bursitis does not involve surgery. Many cases of hip bursitis are treated effectively with simple lifestyle changes such as:
- Modifying activities (i.e., avoiding the activities that make it worse)
- Using non-steroidal anti-inflammatory medications (NSAIDs) to control inflammation and pain (i.e., ibuprofen, naproxen, piroxicam (Feldene), diclofenac (Voltaren) , Celebrex and others)
- Using a walking cane or crutches for a week or more when needed
Physical Therapy: patients claim it is helpful to reduce the pain. Your doctor will talk to your physical therapist to teach you how to stretch the hip muscles and use “modalities” such as ice/heat, ultrasound, and other treatments .
Injections of corticosteroids & analgesics into the bursa: very helpful in reducing pain and inflammation and relieving some of the symptoms of hip bursitis. Often 2-3 injections, given a few weeks apart, are necessary. Many patients will experience immediate relief from a hip injection (due to the anesthetic). The steroid may take a few days before it starts to work.
Treatment Options: Surgical
Surgery is very rarely needed for hip bursitis. In cases where the bursa remains inflamed and painful after non-surgical measures have been taken, and your doctor is certain that the diagnosis is correct, the bursa can be surgically removed. This involves giving you either general anesthesia (being put to sleep), or regional anesthesia (spinal anesthetic or nerve block with a sedative). A 3-inch to 4-inch incision is made over the bursa, and it is removed. Removal of the bursa does not hurt the hip and the hip can actually function normally without it.
A newer technique that is gaining popularity is removal (excision) of the bursa with minimally invasive arthroscopic surgery. This involves making two 1/4-inch incisions over the hip, and inserting a camera (arthroscope) in one incision, and a surgical instrument in the other to cut out the bursa. This surgery is much less invasive, and recovery is quicker and a little less painful. Both types of surgeries are done on an outpatient (day surgery) basis, so an overnight stay in the hospital is not usually necessary.
Following surgery, most patients find that using a cane or crutches for a couple of days is helpful. It is reasonable to be up and walking around the evening after surgery. The soreness from surgery lasts for a variable amount of time, but usually resolves after a few days.