Understanding Hip Bursitis: Causes and Key Insights

Hip bursitis most often involves the bursa that covers the greater trochanter of the femur, although the iliopsoas bursa can also become inflamed.

Symptoms of Trochanteric Bursitis

The hallmark symptom of trochanteric bursitis is pain localized at the outer point of the hip, often radiating down the outer thigh. In the initial stages, this pain is typically sharp and intense. Over time, it may evolve into a dull ache that spreads across a broader area of the hip. Pain is frequently more pronounced at night, especially when lying on the affected side. It also tends to intensify after sitting for extended periods and attempting to stand, as well as during activities such as prolonged walking, stair climbing, or squatting.

Risk Factors for Hip Bursitis

While hip bursitis can affect individuals of any age or gender, it is more commonly observed in women and those who are middle-aged or older. It is less prevalent among younger individuals and men. Several factors can increase the likelihood of developing this condition:

• Repetitive Stress or Overuse Injuries: Activities like running, stair climbing, cycling, or standing for prolonged periods can place repetitive strain on the hip, leading to bursitis.
• Hip Injuries: Falls, direct impacts, or extended pressure on the hip'such as lying on one side for a long time'can trigger inflammation.
• Spinal Conditions: Disorders like scoliosis, arthritis of the lower spine, or other spinal abnormalities can alter gait patterns and contribute to hip bursa irritation.
• Leg-Length Discrepancy: Significant differences in leg length can disrupt walking mechanics, increasing stress on the hip bursa.
• Rheumatoid Arthritis: This autoimmune condition predisposes bursae to inflammation, heightening the risk of bursitis.
• Prior Hip Surgery: Surgeries near the hip joint or the presence of prosthetic implants can irritate the bursa, leading to inflammation.
• Bone Spurs or Calcium Deposits: These abnormalities within tendons attached to the greater trochanter can rub against the bursa, causing irritation and inflammation.

Diagnosing Hip Bursitis: What to Expect During a Doctor's Examination

To accurately diagnose hip bursitis, a healthcare provider will begin with a thorough physical examination, focusing on identifying tenderness or pain near the outer point of the hip. This evaluation helps pinpoint the inflamed bursa and assess the extent of the condition. In addition to the physical exam, the doctor may order diagnostic tests to exclude other potential injuries or underlying conditions that could mimic bursitis symptoms. These tests often include:

• X-rays: To evaluate the bone structure and detect any abnormalities, such as arthritis or bone spurs, that may contribute to hip pain.
• Bone Scans: Useful for identifying stress fractures or other bone-related issues that might not be visible on an X-ray.
• Magnetic Resonance Imaging (MRI): Provides detailed images of the soft tissues around the hip, including bursae, tendons, and muscles, to confirm inflammation or identify other soft tissue injuries.

By combining clinical examination findings with imaging results, the doctor can make an accurate diagnosis and recommend appropriate treatment options.  

Your doctor will check for tenderness over the bony point of the hip bone.

Effective Nonsurgical Treatments for Hip Bursitis

• Activity Modification: Avoid activities that exacerbate symptoms, such as prolonged standing, repetitive movements, or intense physical exertion, to reduce strain on the affected hip.
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Over-the-counter or prescription medications like ibuprofen, naproxen, piroxicam, or celecoxib can help manage pain and inflammation. It is crucial to use NSAIDs cautiously, especially if you have underlying medical conditions or take other medications. Consult your doctor to determine the safest option and appropriate duration for use.
• Assistive Devices: Temporary use of a walking cane or crutches can minimize pressure on the affected hip, aiding in recovery. These devices are typically recommended for a week or more, depending on the severity of symptoms.
• Physical Therapy: A physical therapy program may include exercises to stretch and strengthen the iliotibial (IT) band and hip muscles, enhancing flexibility and stability. Techniques such as rolling massage therapy, as well as the application of ice, heat, or ultrasound, may also be employed to alleviate pain and promote healing.
• Steroid Injections: Corticosteroid injections, often combined with a local anesthetic, can provide significant relief from pain and inflammation. This quick and minimally invasive procedure is performed in a doctor's office and typically delivers temporary relief lasting several months. If symptoms recur, additional injections may be considered, although limiting their frequency is essential to avoid potential tissue damage. Identifying and addressing the underlying cause of bursitis remains critical for long-term management.