Hip Bursitis

Bursae are small fluid-filled sacs in the body that help in the smooth gliding of the muscles, tendons, ligaments over the bony prominences. There are two major bursae in the hip joint, the trochanteric bursa and the iliopsoas bursa. Inflammation of the bursae is a common cause of hip pain. The pain may be managed with medications, change of activity, injections, and rarely surgery.

The inflammation of these bursae causes bursitis. The inflammation may occur as a result of wear and tear, irritation, or direct trauma/injury to the region. During inflammation, the body tries to repair the damage to the bursae that may cause swelling and pain.

X-ray of the hip joint and its relation to the trochanteric bursa and iliopsoas bursa.

Trochanteric bursa

The trochanteric bursae is a small sac of fluid present at the side of the hip joint. The bursae allow the smooth gliding between the hip abductor muscles, tensor fascia, and the greater trochanter. The greater trochanter is bony prominence at the upper end of the thigh bone at the side of the hip joint.

Iliopsoas bursa

The iliopsoas bursa helps in the smooth gliding of the iliopsoas tendon over the front of the hip joint. The bursa may get inflamed and cause pain and tenderness. The pain is typically situated in front of the hip joint.

Causes

• A direct injury to the hip region may cause inflammation of the bursae. The injury may be associated with a fall or maybe sustained playing contact sports or during a motor vehicle accident.
• Repetitive motion about the hip joint may cause irritation of the bursae. The iliotibial band passes on the side of the trochanteric bursae and repetitive motion leading to sliding of the band over the bursae may cause inflammation. Activities such as running, jogging, athletics, cycling, etc. are the usual culprits.
• Inflammatory diseases such as rheumatoid arthritis make the bursae more liable to be inflamed.
• Abnormal deposition of calcium in the tendons that pass over the bursae may irritate the bursae and cause inflammation.
• Any prior surgeries around the hip joint may lead to bursitis. Additionally, any birth deformities or a complication of total hip replacement that may cause leg length discrepancy may also lead to hip bursitis.

Symptoms

Patients with trochanteric bursitis may complain of sharp pain on the side of the hip. The pain may also be described as a dull ache spreading over the side of the hip. The pain is more severe with activities such as walking, running, climbing stairs, etc.

The pain associated with the iliopsoas bursa is repeated in the groin region in front of the hip joint. The pain of bursitis in both cases may get worse at night especially on sleeping on the side of the inflamed bursa.

Diagnosis & Management

The diagnosis of hip bursitis is made by the physician after eliciting the history of events leading up to the current symptoms and a thorough physical examination. During the physical examination, the physician may perform tests to localize the pain. Radiological tests in the form of X-ray, CT scan, or MRI may be performed to help in the diagnosis in cases where the physical examination is inconclusive.

The management of hip bursitis is mainly nonoperative. The patients are advised to modify their physical activity in cases where repetitive motion leads to inflammation of the bursa. Non-steroidal anti-inflammatory medications such as naproxen and ibuprofen may be prescribed to reduce inflammation and pain.

The prolonged intake of NSAID medications may however cause stomach ulcers and may increase the risk of bleeding. The NSAID medications are therefore prescribed only for a short period of time.

Physical therapy may help to increase the flexibility and the strength of the muscles around the hip joint that may reduce the risk of bursitis. Similarly, icing may be helpful in acute cases of bursitis. The icing helps by reducing inflammation and soothing the nerves to help reduce pain.

Depo-Medrol used as a steroid shot in cortisone injection.

Cortisone steroid injections mixed with a numbing medication such as lidocaine may lead to temporary or permanent relief from bursitis. The steroid in the injection helps to reduce the inflammation, while the lidocaine helps by immediately numbing the nerves around the bursa leading to pain relief. The steroid injection may provide relief for a few days, weeks, or months. The steroid injection may be repeated if needed in some cases.

Surgical management of hip bursitis is rare but may be performed using keyhole surgical techniques using an arthroscope. The surgeon makes a small incision in the hip region and inserts a miniature camera along with instruments. The surgeon may then open up and remove the offending bursa. The surgery may be performed in an outpatient setting and patients are up and walking the day of the procedure.