Hip Bursitis
What Is Hip Bursitis?
Bursae are small sacs containing a little fluid that sit around a joint; they act as a cushion between bone and soft tissue and reduce friction during movement. Hip bursitis is inflammation or irritation of one of these sacs.
Two bursae stand out at the hip: the bursa over the outer prominence of the femur (the greater trochanter) and the iliopsoas bursa at the front of the groin. Trochanteric bursitis causes pain on the outer side of the hip, whereas iliopsoas bursitis causes pain more in the groin. For other hip problems you can review the hip page.
It is now known that most pain on the outer side of the hip arises not only from the bursa but also from wear of the tendons in the area (the gluteal tendons); this picture is called greater trochanteric pain syndrome. For this reason treatment is directed not only at the bursa but also at the surrounding muscles and tendons.
What Causes It? Risk Factors
Hip bursitis usually develops through repetitive load and mechanical factors that strain the area. It is more common in women and in middle-aged and older people.
- Repetitive overuse: long walks and running, frequent stair climbing or lying on the same side for long periods.
- A tight iliotibial band and weakness of the hip abductor muscles.
- A difference in leg length, malalignment and spinal problems (scoliosis, low-back arthritis).
- A blow to the hip area, previous hip surgery, inflammatory diseases and bony prominences or calcifications in the area.
Symptoms
The most common symptom is pain on the outer side of the hip; in iliopsoas bursitis the pain is felt in the groin. The pain can begin insidiously and become more prominent over time.
- Pain and tenderness on the outer side of the hip that can spread down the thigh.
- Pain that increases when lying on the affected side and breaks sleep at night.
- Pain that worsens when getting up after prolonged sitting, while walking and climbing stairs.
Conditions That Can Be Confused With It
There are many causes of pain around the hip, and examination tells them apart. Arthritis and impingement arising from within the joint usually cause deep groin pain that increases with rotation and squatting, whereas in bursitis the pain is on the outer side of the hip and becomes prominent with pressure over the bony prominence.
Runner's pain that spreads to the outer side of the knee suggests iliotibial band syndrome, and pain that spreads to the lower back and leg suggests nerve compression arising from the spine. This distinction changes the treatment directly, so the location of the pain and its triggers are assessed carefully.
Diagnosis: Examination and Imaging
The diagnosis is usually made from the history and physical examination. Reproduction of the pain with pressure over the greater trochanter is typical; the range of motion of the hip, muscle strength and alignment are assessed.
Imaging is not needed in every patient. An X-ray is used to exclude arthritis and calcifications, and ultrasound or MRI when an accompanying problem such as a tendon tear is suspected or when the expected response to treatment does not occur.
Non-Surgical Treatment
The large majority of hip bursitis settles with non-surgical measures. The aim is to reduce pain and irritation and then to correct the underlying mechanical factors.
- Activity modification: temporarily reducing the movements that provoke pain and avoiding lying on the affected side.
- Short-term anti-inflammatory medication and cold application under medical advice to manage pain and inflammation.
- Physiotherapy: strengthening the hip abductor muscles, stretching the iliotibial band and correcting walking mechanics.
- In resistant cases, a corticosteroid injection into the bursa in selected patients; this is planned alongside an exercise programme.
Exercise and Rehabilitation
Physiotherapy is the most important step in treating hip bursitis and preventing recurrence. The aim is to reduce the mechanical load on the bursa to relieve pain and to strengthen the support around the hip.
- Progressive strengthening of the hip abductor and trunk muscles.
- Stretching the tight iliotibial band and the muscles around the hip within the limits of pain.
- Reviewing and correcting walking mechanics and daily movement habits.
The exercise programme progresses gradually as pain settles; forceful stretches that increase pain are avoided in the early period. As the hip abductor muscles strengthen the load on the bursa decreases and the chance of recurrence falls, so continuing the programme for a while even after relief is advised.
When Is Surgery Needed?
Surgery is rarely needed for hip bursitis. It is considered in selected patients whose symptoms persist despite adequate, well-conducted non-surgical treatment.
In these situations removing the inflamed bursa and, where needed, releasing the tight band or repairing an accompanying tendon problem may come onto the agenda; the procedure is usually done arthroscopically (endoscopically). The decision is made on an individual basis.
Recovery and Prevention
Bursitis usually has a good outcome when managed correctly; however, it tends to recur if the underlying factors are not corrected. Recovery time varies from person to person and is supported by regular exercise.
- A regular exercise programme that keeps the hip abductor muscles strong and the iliotibial band flexible.
- Weight control, suitable footwear and increasing walking and running load gradually.
- Avoiding lying on the same side for long periods and repetitive overload.
When Should You See a Doctor?
Having hip pain assessed early ensures that an underlying muscle imbalance and tendon problems are not missed.
- Pain on the outer side of the hip has lasted for several weeks and affects your sleep and daily activities.
- The pain does not settle despite rest and simple measures, or it recurs.
- There is fever, marked swelling, redness or sudden severe pain; these suggest a different problem.
For the assessment of hip symptoms you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within hip surgery.