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Hip Bursitis

Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.

Bursitis is inflammation of the bursa. There are two major bursae in the hip that typically become irritated and inflamed. One bursa covers the bony point of the hip bone called the greater trochanter. Inflammation of this bursa is called tronchanteric bursitis.

Hip bursitis most often involves the bursa that covers the greater trochanter of the femur.

Symptoms

The main symptom of trochanteric bursitis is pain at the point of the hip. The pain usually extends to the outside of the thigh area. In the early stages, the pain is usually described as sharp and intense. Later, the pain may become more of an ache and spread across a larger area of the hip.

Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while. It also may get worse with prolonged walking, stair climbing, or squatting.

Risk Factors

The following risk factors have been associated with the development of hip bursitis.
  • Repetitive stress (overuse) injury. This can occur when running, stair climbing, bicycling, or standing for long periods of time.

  • Hip injury. An injury to the point of your hip can occur when you fall onto your hip, bump your hip, or lie on one side of your body for an extended period of time.

  • Spine disease. This includes scoliosis, arthritis of the lumbar (lower) spine, and other spine problems.

  • Leg-length inequality. When one leg is significantly shorter than the other, it affects the way you walk, and can lead to irritation of a hip bursa.

  • Rheumatoid arthritis. This makes the bursa more likely to become inflamed.

  • Previous surgery. Surgery around the hip or prosthetic implants in the hip can irritate the bursa and cause bursitis.

  • Bone spurs or calcium deposits. These can develop within the tendons that attach muscles to the trochanter. They can irritate the bursa and cause inflammation.
Doctor Examination

To diagnose hip bursitis, Dr. Parikh and his team will perform a comprehensive physical examination, looking for tenderness in the area of the point of the hip. He may also perform additional tests to rule out other possible injuries or conditions. These tests can include x-rays, Bone Scanning or MRI.

Treatment

Nonsurgical

The initial treatment for hip bursitis does not involve surgery. Many people with hip bursitis can experience relief with simple lifestyle changes, including:

  • Activity modification. Avoid the activities that worsen symptoms.

  • Non-steroidal anti-inflammatory drugs (NSAIDs). Ibuprofen, naproxen, piroxicam, celecoxib, and others, may relieve pain and control inflammation.Use NSAIDs cautiously and for limited periods. Talk with your doctor about the NSAIDs you use. NSAIDs may have adverse side effects if you have certain medical conditions or take certain medications.

  • Assistive devices. Use of a walking cane or crutches for a week or more when needed.

  • Physical therapy. Your doctor may prescribe exercises to increase hip strength and flexibility. You may do these exercises on your own, or a physical therapist may teach you how to stretch your hip muscles and use other treatments such as rolling therapy (massage), ice, heat, or ultrasound.

  • Steroid injection. 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 may provide temporary (months) or permanent relief. If pain and inflammation return, another injection or two, given a few months apart, may be needed. It is important to limit the number of injections, as prolonged corticosteroid injections may damage the surrounding tissues.

Surgical

Surgery is rarely needed for hip bursitis. If the bursa remains inflamed and painful after all nonsurgical treatments have been tried, Dr. Parikh and his team may recommend surgical removal of the bursa. Removal of the bursa does not hurt the hip, and the hip can function normally without it.

Surgery is done on an outpatient (same-day) basis, so an overnight stay in the hospital is not usually necessary.

Rehabilitation

Following surgery, a short rehabilitation period can be expected. Most patients find that using a cane or crutches for a couple of days is helpful. It is reasonable to be up and walking around the evening after surgery. The soreness from surgery usually goes away after a few days.

Prevention

Although hip bursitis cannot always be prevented, there are things you can do to prevent the inflammation from getting worse.

  • Avoid repetitive activities that put stress on the hips.

  • Lose weight if you need to.

  • Get a properly fitting shoe insert for leg-length differences.

  • Maintain strength and flexibility of the hip muscles.


Information obtain from www.orthoinfo.aaos.org

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