Bursitis

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Introduction

Nearly 60 percent of cases of hip pain are caused by trochanteric bursitis, the painful inflammation of the bursa that covers the part of the thighbone (femur) called the greater trochanter. Triggered by an injury or disease, this form of bursitis can affect anyone, but is more common in women and the middle-aged or elderly than in men or younger people.

Anatomy

Small fluid-filled sacs (bursae) cushion the spaces between muscles, tendons, and bones throughout the body. In the hip, several bursae sit on the outside portion of the thighbone, which is called the greater trochanter. This is a broad, flat area of bone that keeps several large muscles in place. (If you press against the side of your hip, you can feel the greater trochanter.) If one of the trochanteric bursa becomes irritated or inflamed, it may gradually thicken and cause pain.

Causes

Abnormal patterns of walking and standing cause 95 percent of the cases of hip bursitis. These gait problems may simply be the result of standing too long, or may result from a difference in the length of the legs. Either of these situations may put extra pressure on the hip, resulting in irritation and inflammation of the bursae.

Other problems that can cause trochanteric bursitis include a fall, injuries from overuse or minor accidents, previous hip surgery or hip replacement, minor traumatic injuries, scoliosis or other spinal diseases, and rheumatoid arthritis. It can also occur if you lie on one side of the body for too long (perhaps while recovering from an injury).

Symptoms

If you have this type of bursitis, your main symptom will be pain. You may, for example, feel aching pain on the outer thigh, right over the bone. Or your pain may extend along the outside of the leg down to the knee. The pain will feel worse when you lie down or roll over on the hurting side. It may hurt when you climb stairs, sit or stand too long, or walk. Pain at night may make it difficult to sleep. Other symptoms include soreness or stiffness of the hip.

Diagnosis

A history and physical exam will help your doctor make the diagnosis.

Tenderness located over the area of the greater trochanter helps to confirm the diagnosis. An x-ray of both the hip and back will reveal any leg-length discrepancies, back problems, or conditions in the sacroiliac (the area of the lower back where the spine meets the pelvis) that may cause walking abnormalities that can lead to bursitis.

An MRI may also be needed to identify the source of walking problems and rule out a tumor, or avascular necrosis.

Treatment

The goals of treatment focus on reducing inflammation, correcting any gait disturbance, and preventing future episodes.

Rarely, a bursa may have to be surgically removed. If this becomes necessary, the doctor will remove the sac through an incision made over the top of the hip. After the procedure, you’ll probably need to stay off your feet for a few days to let the incision heal.