Hip bursitis is a very common hip problem that causes pain along the outside of the upper thigh. It can occur in athletes who must do a lot of running as part of their training. It is most common in runners, but also seen in bikers, soccer players, and football players. It can also occur after a fall onto the hip and may be associated with bruising in the area. Finally, hip bursitis is seen in patients who have had a hip fracture surgery or hip replacement, where the surgery causes irritation of the bursa overlying the greater trochanter.
The bony prominence that can be felt in the upper thigh is called the greater trochanter. This is an area on the femur (thigh bone) that allows for the attachment of many muscles. One of the muscles that attaches to this area is the Iliotibial Band or IT Band. Between the IT band and the greater trochanter, there is a small fluid filled sac called a (shown in yellow above) A bursa allows smooth gliding between two surfaces in the body, in this case the IT band and the greater trochanter. When the bursa gets inflamed, it causes pain every time the IT band rubs over the bursa and the greater trochanter.
The diagnosis of trochanteric bursitis is made by the history and physical exam. Patients often complain of a burning pain on the outside of the upper thigh. The pain can travel down the outer thigh, but rarely crosses the knee. Patients often are tender in the area of the bursa, and have difficulty sleeping on that side. On the physical exam, patients will be tender in the area of the bursa and will often have a very tight IT band over the area. X-rays are usually taken, but do not usually show anything. An MRI is sometimes ordered if the diagnosis is in question or to make sure there is nothing else going on in the area.
The initial treatment of trochanteric bursitis is rest, anti-inflammatories, ice, and stretching in order to allow the bursa to recover.
consists of a period of time where participation in any activity (for example, running or biking) that causes pain to the hip bursa.
medications such as motrin, aleve, or ibuprofen can be very helpful in controlling the inflammation and pain associated with the bursitis.
can help improve the symptoms of bursitis, especially following exercise and physical therapy.
many patients with trochanteric bursitis have a very tight IT band. A course of stretching the IT band usually improves the symptoms dramatically over a course of just a few weeks.
If these initial treatments do not alleviate the symptoms, there are other treatment options:
An injection of cortisone can be given directly into the bursa in patients who continue to have pain despite rest, medication, and stretching. The cortisone is a powerful anti-inflammatory and can make patients feel significantly better. It is usually given with lidocaine, an anesthetic, which give immediate pain relief.
Rarely, surgery is necessary for trochanteric bursitis that does not get better with all of the above treatments. The surgery can be done either with a small incision, or arthroscopically. The procedure is an outpatient procedure and patients can walk the following day with only mild pain.
Overall, most patients get better with rest, anti-inflammatories, and a stretching program directed by a physician, athletic trainer, or physical therapist. Patients can expect to see improvement in symptoms quickly, with a resolution of symptoms most often after 6 to 10 weeks. It is important to gradually resume activities so as to not develop bursitis again.