Hip pain is common and can be disabling. It affects people of all ages. Bursitis is a common cause of musculoskeletal pain. Diagnosis requires distinguishing it from arthritis, fractures, overuse injury, tight buttocks and hip muscles, spine problems, tendinitis and nerve problems.
What are bursae?
Bursae are small sacks of lubricating (synovial) fluid that are located between the bones of the hip, shoulder, elbow, knee and heel and cushion the bones, tendons and muscles. They function to protect and lubricate the joint, prevent excessive friction of soft tissue over bony bumps or prominences during motion, and provide cushioning during movement.
What is hip bursitis?
Hip bursitis is swelling and inflammation of the bursa between the thigh bone and nearby tendons that irritate the tendons and cause pain on the outside of the hip.
What are the types of hip bursitis?
There are two primary bursae in the hip that become inflamed and irritated. One is the bursae that covers the end of the greater trochanter of the femur, the bony point of the hip. This is called trochanteric bursitis. Trochanter bursitis is most common and causes lateral hip pain. The other is the iliopsoas bursa located inside the hip by the groin. This type is less common and is not reviewed here.
Greater Trochanteric Pain Syndrome (GTPS)
GTPS is also called Hip Bursitis that can be acute or chronic. Most often it is a slowly progressive condition caused by friction, overuse, or trauma.
What are the risk factors for GTPS?
- Middle aged and elderly women
- Repetitive stress caused by running, stair climbing, bicycling and standing for long periods
- knee pain
- low back pain
Falls on the hip and overuse injuries, scoliosis, lumbar spine arthritis, rheumatoid arthritis, psoriatic arthritis, gout, thyroid diseases, bone spurs, calcium deposit, hip implants. Sometimes the cause cannot be identified.
In early stages, the pain is sharp and intense pain at the point of the hip and radiates down the outside of the thigh to the knee. Pain can worsen with weight bearing activities. As the condition progresses the pain may develop into a deep ache that spreads across the hip. Pain that worsens at night, when lying on the affected hip and when getting out of a chair after sitting for a period; and pain worsens with prolonged walking, climbing stairs or squatting are signs that it’s time to see a doctor.
It is important to receive an accurate diagnosis early in the acute phase as delay and mismanagement can worsen the condition and cause it to become chronic. Your board – certified OANC orthopedic surgeon must rule out the other conditions that can cause lateral hip pain. Frequently bursitis can be diagnosed by physical exam looking for tenderness on the outside of the hip and using a combination of range of motion and other tests. X-rays can rule out arthritis, gout, scoliosis, bone spurs, calcium deposits, implants. Diagnostic ultrasound and MRI are useful to confirm a diagnosis.
Conservative management with NSAIDS, icing, activity modification, steroid injections, and physical therapy are first line treatment. A majority of cases can be successfully managed with conservative measures. Surgical intervention is reserved for cases where conservative management has failed. Arthroscopic outpatient surgery involves removal of the affected bursae.
Hip pain can affect your quality of life. When you have hip pain and have tried to manage it on your own, but it won’t resolve, it is time to see an OANC orthopedic surgeon. Contact us to schedule a consultation today.