Hip-Bursitis

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Hip Bursitis

 

Bursitis is one of the most common causes of hip pain.  Bursa tissue is located throughout the body, including around the hip, shoulder, elbow, knee, and heel. Bursa tissue is positioned between bones and soft tissues, acting as cushions to help reduce friction. “Bursitis” is the term used to describe inflammation of a bursa.

Hip bursitis most often involves the bursa that covers the “greater trochanter” of the femur—the bony point on the side of the hip.  This bursa cushions the greater trochanter as it moves against the soft tissue around the hip. Inflammation of this bursa is called trochanteric bursitis.

Symptoms

The main symptom of trochanteric bursitis is pain and tenderness on the side of the hip. The pain usually extends to the outside of the thigh area. Often there can be pain when getting up from a chair after being seated for a while. It also may get worse with prolonged standing, walking or running, stair climbing, or squatting. Typically, the pain is worse at night, when lying on the affected hip.

Trochanteric bursitis typically causes the following symptoms:

  • Pain on the outside of the hip and thigh or in the buttock.
  • Pain when lying on the affected side.
  • Pain when you press in or on the outside of the hip.
  • Pain that gets worse during activities such as getting up from a deep chair or getting out of a car.
  • Pain with walking up stairs.

What Causes Hip Bursitis?

Trochanteric bursitis is thought to be caused by the friction of the bursa tissue as the greater trochanter rubs against a tendon called the iliotibial band (also called the IT band) that runs along the side of the thigh from the hip to the knee, like a big rubber band.  The bursa tissue lies between these structures.  With activity, the iliotibial band can exert a significant amount of pressure on the bursa as it slides back and forth over the great trochanter. As the hip moves back and forth, the bursa tissue can become inflamed.  The inflamed thickened bursa tissue is even more sensitive to friction and irritation—leading to a cycle of inflammation and pain.  Chronic inflammation can also lead to tears and inflammation of the other tendons and muscles that attach to the greater trochanter.

There are many factors that can contribute or lead to trochanteric bursitis. Some of them include:

  • Weakness of hip muscles
  • Repetitive activities such as walking, jogging or bicycling
  • Tightness of the iliotibial band--can cause increased pressure on the bursa, triggering inflammation and swelling
  • Trauma to the side of the hip can provoke inflammation and thickening of the bursal tissue.
  • Changes in gait due pain in other joints, the low back or injuries
  • Previous surgery around the hip or prosthetic implants in the hip.
  • Hip bone spurs or calcium deposits in the tendons that attach to the trochanter

Treatment

Treatments are generally nonsurgical and easy to do at home. They might include:

  • Activity modification - Avoid the activities that worsen symptoms
  • Ice - Apply ice packs to your hip every 4 hours for 20 to 30 minutes at a time. Cold numbs the area, which can reduce pain and may cut down on swelling and inflammation.
  • Anti-inflammatory medications - Over-the-counter medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve) can reduce pain and swelling.
  • Rest - If you can stay off your hip, you can give it time to heal. Using walkers, crutches, and other tools may help as well.
  • Stretches and exercises -  Stretches and exercises can improve flexibility and strengthen your muscles.
  • Assistive devices - Use of a walking cane or crutches for a week or more when needed, to reduce pressure on the hip.

If these basic treatment options do not provide enough relief, come see us in the office to discuss additional treatment options. They might include:

  • Physical therapy - Reducing the friction against the bursa is important for long term relief.  A physical therapist can evaluate you and teach you specific exercises to improve flexibility and strengthen your muscles to relive pressure on the hip bursa. They can also use other treatments such as rolling therapy (massage), ice, heat, or ultrasound to help reduce inflammation.

 

 

  • Steroid injection - 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 office. It involves a single injection into the bursa. The injection may provide temporary (months) or permanent relief. If pain and inflammation return, another injection, given a few months apart, may help.

 

  • Prescription Anti-inflammatory medications - can be more effective that over the counter medications .
  • Low-energy shock wave therapy - Acoustic shock waves are passed through the skin with a targeted device. Studies have shown that shock wave therapy can provide relief when other simple fail to give enough relief.
  • Platelet rich plasma (PRP) injections - These injections can stimulate biologic healing of damaged or inflamed tissue in the bursa.

 

Surgical Treatment

Surgery is rarely needed for hip bursitis. If the bursa remains inflamed and painful after all nonsurgical treatments have been tried, surgical removal of the bursa may be discussed. Removal of the bursa does not hurt the hip, and the hip can function normally without it.

A newer technique that is gaining popularity is arthroscopic removal of the bursa. In this technique, the bursa is removed through a small (1/4-inch) incision over the hip. A small camera, or arthroscope, is placed in a second incision so to guide miniature surgical instruments and cut out the bursa. This surgery is less invasive, and recovery is quicker and less painful.

Both types of surgeries are done on an outpatient (same-day) basis, so an overnight stay in the hospital is not usually necessary. Early research shows arthroscopic removal of the bursa to be quite effective, but this is still being studied.

Rehabilitation

Following surgery, a short rehabilitation period can be expected. 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 usually goes away after a few days.

Prevention

Although hip bursitis cannot always be prevented, there are things you can do to prevent the inflammation from getting worse.

  • Avoid repetitive activities that put stress on the hips.
  • Lose weight if you need to. It’s a sure way of taking pressure off your hips.
  • Maintain strength and flexibility of the hip muscles.
  • Exercise the right way. It’s great being active, but train properly. That means stretching, warming up, and listening to your body.
  • Wear proper orthotics or inserts. One cause of trochanteric bursitis is having one leg shorter than the other. Inserts can even out your gait.

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