What is Hip Bursitis

Bursitis is a common and often painful condition involving irritation or inflammation of a bursa—a fluid-filled sac-like enclosure at the joint that protects muscles and tendons from bone. Bursitis occurs most commonly in the shoulder, elbow, and hip joints although it may also occur in other joints. Bursitis accounts for less than 1% of all primary care visits but is appreciably prevalent in the adult population.

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The focus of this article is on bursitis of the hip joints, of which there are two general types: iliopsoas bursitis or “snapping-tendon syndrome” and trochanteric bursitis. Iliopsoas bursitis is inflammation of the bursa adjacent to the iliopsoas tendon and is more common in young adults, particularly women. It is commonly called snapping-tendon syndrome because a snap during hip flexion may be heard or felt from inflamed tissues snapping over other muscles or the pelvic bone protrusion. Trochanteric bursitis is inflammation of the bursa over the greater trochanter muscle and may also present with palpable snapping during joint movement. Trochanteric bursitis occurs at a rate of approximately 1.8 cases per 1,000 at-risk individuals annually and is prevalent in up to 35% of adults, mostly in those aged 40 to 60 years. No gender difference in incidence or prevalence has been unequivocally demonstrated for trochanteric bursitis.

Causes of Hip Bursitis

Screenshot 21Bursitis, in general, is usually caused by direct injury, occupational trauma, or overuse of the joint. Repetitive motions or injuries may cause bursitis to occur more frequently with aging as soft tissues around joints become less flexible. Another important cause is rheumatoid arthritis as chronic arthritic joint inflammation causes swelling and irritation in adjacent structures. Occasionally, bursitis may occur with other systemic diseases such as gout or infection (fungal or bacterial, e.g. tuberculosis). General risk factors include age, repetitive tasks, improper or inadequate stretching before exertion, overtraining, sedentary lifestyle, poor posture, and gait abnormalities. Other conditions such as thyroid disease and diabetes may also contribute.

The two kinds of bursitis of the hip have overlapping etiologies. Iliopsoas bursitis is largely caused by acute or occupational trauma and sports-related injuries. Often, the iliopsoas tendon wears down the adjacent bursa with repetitive hip hyperextension or complex movements, resulting in inflammation and possibly tendinitis of the iliopsoas. This type of hip bursitis is most commonly observed in active individuals who regularly engage in running, competitive track and field events, rowing, and resistance training. Symptoms include pain in the groin that may radiate to the thigh and knee, reports of audible hip snap, tenderness over the femoral triangle, painful stair-climbing, pain with prolonged sitting, and pain with putting on shoes while sitting. Diagnosis is made by a positive Thomas test and a snapping hip maneuver in which an audible or palpable snap is considered positive.

IMG 4401.00 00 44 01.Still005Trochanteric bursitis is a self-limiting disorder caused by acute or repeated direct trauma to the hip joint, such as what may be caused by uneven distribution of a heavy load while standing or walking. Trochanteric bursitis may be associated with gluteal tendinitis and ischial band syndrome or ischial bursitis and may be referred to as “greater trochanteric pain syndrome.” It is more age- and arthritis-related than iliopsoas bursitis. Major risk factors are age, gait abnormalities that put strain on one hip joint, repetitive strain or overuse, engaging in new, aggressive exercise regimens, rheumatoid arthritis, low back pain, lumbar spondylosis, fibromyalgia, leg length difference, and total hip arthroplasty. Trochanteric bursitis is characterized by lateral hip pain noticed with direct pressure such as with side-sleeping or palpitation on the affected joint. The affected joint may feel achy or stiff, hurt more at the extremes of motion range, and may exhibit slight swelling. Diagnosis is made by locating the pain source by palpitation of the lateral hip surface and by observing pelvic position with the patient standing on one leg and then the other. The patient may also be observed for gait abnormalities.

Treatment for Hip Bursitis

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The primary treatment for hip bursitis is rest of the joint from repetitive, irritating activities. Gentle stretching and strengthening exercises may be prescribed gradually as the pain diminishes. If a gait or postural abnormality is detected, it will need to be considered as an underlying cause and corrected. The pain and inflammation of hip bursitis may be relieved with non-steroidal anti-inflammatory drugs. Non-responsive hip bursitis may be treated with direct and precision placement of analgesic and anti-inflammatory medications into the trochanteric bursa under fluoroscopically guided- image technology. Physical therapy may be prescribed to strengthen hip muscles and increase flexibility about the joint, in order to relieve tension around and friction on the bursa. In extreme cases of recalcitrant hip bursitis, the inflamed bursa may be surgically removed in a procedure called bursectomy. Other surgical interventions include muscle tear repair and removal of irritating debris from within the hip joint. Gluteal tendons may be inspected during surgery and repaired for degeneration and detachment as needed.

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Hip bursitis is an inflammatory condition in the hip joints that affects adults of all ages and may be painful and debilitating. Treatments range from rest of the affected joint to radical bursectomy with a variety of options in between. Individuals may take steps to prevent hip bursitis by taking it easy at first with new activities and exercise programs, and gradually increasing the physical demands of these activities after several easy sessions with no adverse outcomes. It is always important to take the time to warm up slowly and gently for physical activities. Regular exercise and efforts to strengthen the muscles around the hip joints will reduce the risk of bursitis from repetitive tasks, but short rests from these tasks should still be taken often. Things to avoid include sitting for long periods and walking while carrying unbalanced and awkward heavy loads on one side of the body. Individuals concerned about hip bursitis should always interpret pain as an indication to ease up on activities that place stress on the hip joints. If hip bursitis develops and the pain lasts longer than a week to two weeks, becomes disabling, or if there is excessive swelling, sharp or shooting pain with exertion, or a fever, then it is time to see a physician.

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