Bursitis is the painful swelling of the bursa. Bursae are small jelly-like sacs that usually contain a small amount of fluid. In healthy conditions, bursae act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone. Hip bursitis is a common problem that causes pain over the outside of the upper thigh and hip joint. It is not confined to the hip, but can also occur in the shoulder, knee and elbow joints.
There are two major bursae in the hip that typically become irritated and inflamed. One bursa covers the bony point of the hip bone, called the greater trochanter. It is an attachment point for muscles that move the hip joint. The trochanter has a fairly large bursa overlying it that occasionally becomes irritated, resulting in hip bursitis (trochanteric bursitis).
Another bursa located on the inside (groin side) of the hip is called the iliopsoas bursa. When this bursa becomes inflamed, the condition is also sometimes referred to as hip bursitis, but the pain is located in the groin area. This condition is not as common as trochanteric bursitis, but is treated in a similar manner.
Causes of Hip Bursitis
There are a number of possible causes of hip bursitis, as well as risk factors that make some individuals more likely to develop hip bursitis than others. The most common causes and risk factors include:
- Hip injury or trauma - An injury to the point of the hip can occur when a patient falls onto their hip, bumps their hip on the edge of a table, or lies on one side of their body for an extended period of time.
- Repetitive pressure on the hip - This can occur when running, stair climbing, bicycling, or standing for long periods of time.
- Bone spurs or calcium deposits - These can develop within the tendons that attach to the trochanter. They can irritate the bursa and cause inflammation.
- Rheumatoid arthritis and gout - These make the bursae more likely to become inflamed.
- Previous surgery - Surgery around the hip or prosthetic implants in the hip can irritate bursae and cause bursitis.
- Spine disease - This includes scoliosis, arthritis of the lumbar (lower) spine, and other spine problems.
- Leg-length inequality - When one leg is shorter than the other by more than an inch or so, it affects walking and can lead to irritation of a hip bursa.
- Age and gender - Bursitis is more common in women and middle-aged or elderly people. It is less common in younger people and in men.
Symptoms of Hip Bursitis
The most common symptom of hip bursitis is pain at the point of the hip. Generally, the pain extends to the outside of the thigh area. Patients with the early stages of disease experience sharp, intense pain and become achier as the pain spreads out, as when the condition progresses to advanced stages. Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while. Pain may get worse by hip movements such as walking, running, squatting, and climbing stairs.
Nonsurgical treatments - include one or more of the following:
- Rest and immobilization
- Modifying exercise regimen - avoiding the activities that worsen symptoms
- Stretching and strengthening exercises for the lower back and hip muscles
- Weight loss – to reduce pressure on the hip
- Physical therapy
- Ice application
- Use of non-steroidal anti-inflammatory drugs, such as ibuprofen, naproxen, piroxicam, celecoxib, and others, to control inflammation and pain
- Use of a walking cane or crutches for a week or more when needed
Surgery is rarely needed for hip bursitis. Avoiding surgery is the best option in most cases; however, in some extreme cases the bursa remains thick and swollen, causing chronic bursitis pain. If the bursa remains inflamed and painful after all nonsurgical treatments have been tried, surgical removal of the bursa is recommended. Removal of the bursa does not hurt the hip, and the hip can actually function normally without it.