Physical Medicine and Rehabilitation

Trochanteric Pain Syndrome (Hip Bursitis)

Anatomy

A bursa is a small, jelly-like sac filled with fluid. By providing a cushion between bones and soft tissues such as tendons and muscles, bursae help reduce friction around joints and enable free movement. Bursae can be found throughout the body, near most major joints, including the shoulder, elbow, knee, heel and hip.

Description

Inflammation is the body's natural response to injury, disease, overuse or degeneration and it often causes swelling, pain or irritation. Inflammation of a bursa is called bursitis.

Hip bursitis is typically the result of inflammation and irritation in one of two major bursae in the hip. One covers the bony point of the hip bone (greater trochanter). Inflammation of this bursa is known as trochanteric bursitis. The other (iliopsoas bursa) is located on the inside, or groin side, of the hip. Although inflammation of this bursa is sometimes referred to as hip bursitis also, the pain is located in the groin area. This condition is less common than trochanteric bursitis, however treatment is similar.

Symptoms

Pain at the point of the hip, usually extending to the outside of the thigh area, is the primary symptom of trochanteric bursitis. Pain is usually described as sharp and intense in the early stages. Later, it may develop into an ache that spreads across a larger area of the hip.

Pain typically worsens at night, when lying on the affected hip, and when standing up after being seated for a while. Prolonged walking, stair climbing or squatting may also cause increased pain.

Risk Factors

Although it can affect anyone, the following risk factors have been associated with the development of hip bursitis.

• Repetitive stress (overuse) injury
• Hip injury
• Spine disease
• Leg-length inequality
• Rheumatoid arthritis
• Previous hip surgery
• Bone spurs or calcium deposits

Nonsurgical Treatment

Initial treatment does not involve surgery. Many people with hip bursitis experience relief from pain by making simple lifestyle adjustments.

• Activity changes—Your doctor may first recommend simply modifying your daily routine and avoiding activities that cause or aggravate symptoms.
• Assistive devices—Use of a walking cane or crutches may be recommended, for a week or more, when needed.
• Steroid injection—An injection of corticosteroid, along with a local anesthetic, may be helpful in relieving the symptoms of hip bursitis.
• Physical therapy—Your doctor may prescribe specific exercises or a hip conditioning program to increase the strength and flexibility of the hip.

Surgery

Surgery is rarely needed for hip bursitis. However, if all nonsurgical treatments have been tried and it remains inflamed and painful, your physician may recommend surgical removal of the bursa.

With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.