What Is Hip Bursitis?
Bursae (more than one bursa) are small liquid-filled sacs that function to reduce friction between the moving parts of around joints. Those little cushions are located between bones and tendons throughout the body. Bursitis happens when those bursae get swollen/inflamed. Around the hip, there are two major bursa that may become inflamed: the trochanteric bursa and the iliopsoas bursa.
The first one protects the bony prominence of the upper part of the femur (the thigh bone), known as the greater trochanter. This inflammation is called trochanteric bursitis. Patients experiencing trochanteric bursitis will commonly feel pain on the side of the hip, mostly over the greater trochanter. This pain may worsen with prolonged activities such as walking or squatting or when lying on the affected side. There may be snapping over the side of the hip due to the iliotibial band (ITB) rubbing against it.
The second bursa is located in front of the hip around the iliopsoas tendon, and similarly, the inflammation here is known as iliopsoas bursitis. Patients with iliopsoas bursitis often experience pain in the groin. This pain is worsened with walking or crossing your legs. Patients may also complain of snapping in the front of the hip, particularly when rotating the hip in and out.
Causes Of Hip Bursitis
Bursitis may affect patients of all ages but is less common in the younger population. Risk factors leading to the development of bursitis are repetitive (overuse) injuries such as running, climbing, and cycling. Leg length discrepancy and abnormal development of the hip joint may put excessive stress on the bursa leading to inflammation. Bursitis may also occur after a traumatic event and in patients with rheumatoid arthritis.
Diagnosing Hip Bursitis
The doctor will go over your medical history, including the nature of your symptoms, and duration, as well as alleviating and aggravating factors. During the physical examination the doctor will assess any areas of tenderness, the range of motion, and strength of the hip, and evaluate for other causes of pain you may be experiencing.
During your visit, an x-ray will likely be obtained to evaluate the bony structure of the hip joint. If there is a question as to the diagnosis, magnetic resonance imaging (MRI), a modality that evaluates soft tissues, may be ordered.
Hip Bursitis Treatment
The initial treatment of hip bursitis, similar to bursitis in other areas of the body, is usually nonoperative. Rest and activity modification is recommended and non-steroidal anti-inflammatory medications will be discussed. Physical therapy will most likely be prescribed focusing on stretching, anti-inflammatory modalities, and strengthening the musculature around the hip. Sometimes, a steroid injection is indicated and may be performed in the office.
Fortunately, most patients’ symptoms resolve with nonsurgical treatment. If however, your symptoms remain, your doctor may discuss surgical removal of the bursa. This procedure will not compromise the function of the hip but may help to alleviate your symptoms. You will likely need additional therapy following this procedure.
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