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Hip bursitis is a common problem that causes pain over the outside of the upper thigh. A bursa is a fluid filled sac that allows smooth motion between two uneven surfaces. For example, in the hip, a bursa rests between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passed over this bone. When the bursal sac becomes inflamed, each time the tendon has to move over the bone, pain results. Because patients with hip bursitis move this tendon with each step, hip bursitis symptoms can be quite painful.
Hip bursitis can be associated with different types of patients:
Athletes: Hip bursitis is commonly seen in runners or athletes who participate in running-oriented sports (e.g. soccer, football, etc.).
Injuries: Hip bursitis is sometimes associated with patients who fall onto their upper thigh, causing a so-called traumatic bursitis. The symptoms are similar to a hip pointer.
Post-Surgical: Patients who have had surgery, such as hip fracture surgery, or total hip replacement, may complain of pain over the outside of the hip. These symptoms are often due to irritation to the bursa causing hip bursitis.
The diagnosis of hip bursitis is made most reliably on physical examination. The most common symptoms of hip bursitis include:
An x-ray is often obtained to ensure there are no bone spurs or calcifications that could be contributing to the problem. Occasionally, Dr. Woodworth may obtain an MRI if the diagnosis is unclear or if the problem does not resolve with treatment.
The initial treatment for hip bursitis does not involve surgery. Many people with hip bursitis can experience relief with simple lifestyle changes, including:
There is little evidence to support the use of physical therapy to treat hip bursitis, but many patients claim that it is helpful. Dr. Woodworth may ask a physical therapist to teach you how to stretch your hip muscles and use other treatments such as ice, heat, or ultrasound.
Injection of a corticosteroid along with a local anesthetic may also be helpful in relieving symptoms of hip bursitis. This is a simple and effective treatment that can be done in the doctor’s office. It involves a single injection into the bursa. The injection typically provides permanent relief. If pain and inflammation return, another injection or two, given a few months apart, may be needed.
Surgery is rarely needed for hip bursitis. If the bursa remains inflamed and painful after all nonsurgical treatments have been tried, your doctor may recommend surgical removal of the bursa. Removal of the bursa does not hurt the hip, and the hip can actually function normally without it.
A newer technique that is gaining popularity is arthroscopic removal of the bursa. In this technique, the bursa is removed through a small (1/4-inch) incision over the hip. A tiny camera, or arthroscope, is placed in a second incision so the doctor can guide the surgical instruments and cut out the bursa. This surgery is much less invasive, and recovery is quicker and less painful.
Both types of surgeries are done on an outpatient (day surgery) basis, so an overnight stay in the hospital is not usually necessary. Early studies show arthroscopic removal of the bursa to be quite effective, but this is still currently being studied.
Woodworth Orthopedics and Sports Medicine will help you decide how to best treat your hip bursitis. Call Dr. Woodworth today at (702) 545-6194 for an appointment.
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