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Bursitis is a painful condition that affects small fluid-filled pads called bursae that act as cushions between bony projections and nearby tendons and muscles. Bursitis is inflammation of the bursa and can be acute or chronic. Bursitis often occurs near joints that perform frequent repetitive motion, most commonly in the shoulders, hips, elbows and knees. Bursae reduce friction between gliding muscles and the bone.

At the Virginia Spine Institute, we more commonly diagnose and treat hip bursitis. The bony point of the hip is on the femur, or leg bone, and is called the greater trochanter. It is a large attachment site for muscles that move the hip joint. The greater trochanter has a large bursa overlying it that if irritated can cause hip bursitis.

WHAT CAUSES BURSITIS?

Bursitis can be caused by overuse or trauma. Repetitive motion, such as throwing a baseball, repetitive kneeling, or running can lead to chronic bursitis. Bursitis can also develop in patients with underlying conditions such as gout, osteoarthritis and rheumatoid arthritis. Often times the cause cannot be determined. 

Hip bursitis can affect anyone, but is more common in middle-aged or elderly women. It is less common in younger people and men. Repetitive motion for the hip may include running, stair climbing, bicycling, or prolonged standing. The hip can more easily develop bursitis after a fall or injury to the hip. Certain spine disorders such as scoliosis, arthritis, leg length discrepancy can all make bursitis more common.

SYMPTOMS

Patients will have tenderness when pressing around the joint. Most patients complain of aching and stiffness during joint movement and may notice areas of swelling over the affected areas. Bursitis causes pain around the affected bone or tendon. Hip bursitis has pain at the point of the hip and it usually extends to the outside thigh. Pain may be felt as sharp and intense or achy and diffuse. Pain is often worse at night, especially when lying on the affected side. It is also worse with hip movement, such as getting up from a chair after being seated, prolonged walking, squatting or stair climbing.

TREATMENT

Treatment options vary for bursitis. Many people with hip bursitis can experience relief with simple lifestyle changes. Temporary rest of the affected joint and avoidance of activities that worsen symptoms aid in recovery. Ice applied directly over the affected area helps reduce inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ibuprofen control inflammation and pain. NSAIDs may have adverse side effects if you have certain medical conditions or take certain medications. Your provider should be aware of NSAIDs you use to make sure these drugs are not contraindicated.

If inflammation does not respond to initial conservative treatments, it may be necessary to directly inject the affected bursa. Injection of a corticosteroid along with a local anesthetic may help relieve symptoms of hip bursitis. Corticosteroids are anti-inflammatory medications that directly reduce inflammation where injected. This is a simple and effective treatment that can be done in the office. The injection typically provides permanent relief. If pain and inflammation return, another injection may be needed. Steroid injections are generally well tolerated but there are side effects to any procedure. Talk with your provider to learn more about steroid injections. 

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