Bursitis of the Hip

Throughout the body, small sacs, sometimes filled with a little fluid, called bursae act as cushions between bones, tendons and muscles. Several bursae are located around the outer area of the hip, near the portion of the thighbone (femur) called the greater trochanter (tro-KAN-ter). The greater trochanter is a broad, flat area of bone that anchors several large muscles. An inflammation of one of the trochanteric bursa is a common cause of hip pain.

Causes of trochanteric (hip) bursitis

Possible causes of trochanteric bursitis include:

• Repetitive stress (overuse) injuries.
  
  
• Multiple minor traumatic injuries.
  
  
• Lumbar spine disease such as scoliosis.
  
  
• Leg-length inequalities.
  
  
• Rheumatoid arthritis.
  
  
• Lying on one side of the body for an extended period (perhaps due to another injury or illness).
  
  
• Excessive or prolonged pressure on the hip such as from standing too long.
  
  
• An acute traumatic incident such as a fall.
  
  
• Previous surgery or prosthetic implants in the hip.

Signs and symptoms

Trochanteric bursitis can affect anyone at any age, although it is more common in women and the middle-aged or elderly than in men or younger people. The main symptom is pain.

• Aching pain is usually focused on the outside of the upper thigh, just over the point of the hip.
  
  
• Pain may radiate down the outside of the thigh as far as the knee.
  
  
• Pain is worse when you lie down or roll over on the affected side.
  
  
• Climbing stairs, sitting or standing too long and walking may all be painful.
  
  
• Pain at night may make sleeping difficult.

Diagnostic tests

The primary diagnostic test is the physical examination. Specific pain centered in one area supports a possible diagnosis of trochanteric bursitis. The physician may request additional tests to eliminate other possible injuries or conditions. An X-ray will show any bony abnormalities or spurs, calcium deposits or other problems within the joint that contribute to the bursitis. Bone scans and MRI (magnetic resonance imaging) may be needed if there is a possible fracture, tumor or tissue death (osteonecrosis) of the femoral head.

Treatment

If the bursitis is caused by overuse, the first step in treating it is rest. Simply giving the hip an opportunity to heal by taking some time off from the activity or by modifying your exercise regimen may be sufficient. Other conservative treatments include:

• Ice applications (apply for 15 to 20 minutes, two or three times a day; do not apply ice directly to the skin).
  
  
• Nonsteroidal anti-inflammatory drugs such as ibuprofen.
  
  
• Stretching exercises, especially for the lower back and hip muscles.
  
  
• Weight loss, to reduce pressure on the hip.
  
  
• Exercises to strengthen the muscles.
  
  
• Physical therapy.
  
  
• Using a cane to reduce pressure on the hip.
  
  
• Using a lift in your shoe if one leg is markedly different in length than the other.

If conservative treatment does not relieve the pain, your physician may recommend an injection of a corticosteroid preparation, which is usually successful in relieving symptoms. Surgery is rarely required. Because persistent pain may be an early sign of hip disease, an MRI may be recommended to diagnose this condition.

Preventing another painful episode

Three steps you can take to prevent hip bursitis from returning are:

1. Avoid prolonged standing or repetitive tasks that involve your hip muscles.
   
   
2. Exercise to strengthen and stretch the muscles in your hips and lower back.
   
   
3. Be sure to see your physician before beginning any exercise program, and to follow a planned program.

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posted 10/1/2000

Your Orthopaedic Connection, Patient Education Web Site of the American Academy of Orthopaedic Surgeons, © 2002