(Bursitis of the Hip)
Trochanteric Bursitis is a condition that causes pain on the side of the hip. The pain often radiates down the side of the thigh to the knee and occasionally to the outside of the calf. Sometimes the pain radiates to the buttock or to the groin. The pain is worse when sleeping at night and when sitting for long periods of time and then standing.
It can be caused by trauma to the side of the hip but more commonly by repetitive overloading of the tendon (iliotibial band) as it passes over the side of the hip. There is a bony prominence (the greater trochanter) that causes friction when the tendon passes over it. This creates inflammation and the body responds by laying down inflammatory tissue and fluid between the tendon and the bone. Some cases involve a snapping sensation on the side of the hip.
Any activity that overloads the tendon can cause a hip bursitis. The most common presentation includes:
- Sitting too much. Especially in low chairs or car seats.
- Standing or walking too much on hard surfaces (i.e. walking through airports, convention halls, etc.)
- Lifting too much. Especially lifitng from low to high or lifting up stairs, (extensive gardening, home improvement projects, long backpacking trips, moving furniture etc.)
- Sleeping on hard mattresses.
- Long-distance running or cycling, which includes running up and down hills.
- Overloading due to an injury or painful condition in opposite leg.
- Trauma due to a fall directly on the side of the hip.
The diagnosis is made by history, physical exam, and the response to a local anesthetic/cortisone injection. X-rays will occasionally demonstrate calcium deposits and rule out hip joint arthritis. MRI scans are sometimes used to confirm the diagnosis and to rule out a tear of one of the deep tendons (gluteus medius tendons), which connect to the top of the femur bone.
Other conditions that mimic and can be confused with hip bursitis include:
- Referred mechanical low back pain (sacroiliitis and lumbar spine arthritis)
- Avoid sitting in low chairs. Place pillows on your car seat and move the seat back. Elevate your chair and workstation. Consider a semi-sitting position at work with a bar stool like chair.
- Use well cushioned shoes with gel pads or orthotics. If you stand at work, consider using a carpet with extra padding or a gel pad beneath your feet. Work on and off a bar stool.
- Do not carry luggage, tools, equipment, books etc. Use luggage with rollers, equipment carts, briefcases, and other totes with wheels.
- Avoid lifting from low to high when possible including groceries, laundry, etc.
- Avoid stairs or limit the round trips you go up and down stairs. Leave items at the bottom of the stairs, and arrange for someone else to carry them upstairs.
- Sleep with a pillow between your knees. Try a pillow top mattress cover to soften the bed.
- Rest from running or strenuous hill hiking. Cross train with swimming or gentle cycling, When returning to running, run shorter distances on a flat course at first, then gradually increase your distances over a six to eight week period. Check to see if your running shoes have adequate cushioning and shock absorption. Consider orthotics or over the counter arch supports.
- Use a hiking stick (trekking stick) or cane on the opposite side to offload the painful side. Use this for any extensive walking, traveling, or hiking.
- Anti-inflammatory medications such as Advil (Ibuprofen) or Aleve (Naproxen) may help with mild to moderate cases. Discontinue use if you develop abdominal symptoms. Obtain blood tests if you use these medications daily for long periods of time to check for kidney, and rarely, liver problems.
- Cortisone injections. These can be very effective in reversing the inflammation and pain.
- Ice. This treatment does not seem to help very much because the inflammation is too deep.
- Stretching. Stretching the iliotibial band can relieve pressure and pain. This can be performed by lying on side of the hip that is unaffected. Cross the knee of the affected side over the unaffected side over the unaffected leg and touch the knee to the ground. Push the affected hip backward with our hand to stretch the IT Band. Hold this position for a sustained count of 20 seconds. Repeat 10-15 times.
- Physical Therapy. Therapists use local modalities such as ultrasound and electrical stimulation to reduce inflammation. Exercise programs can help to stretch, strengthen and improve gait and balance problems.
Surgery is utilized as a last resort for severe chronic cases. Both arthroscopic and open surgical techniques are used to remove the inflamed bursa and to relax or lengthen the iliotibial band if necessary.
Gluteus Medius Tendon Tears (The Rotator Cuff Tear of the Hip)
Patients that have a significant limp and intractable pain may have a tear of the deep tendon that attaches to the top of the femur. This may be confirmed on an MRI scan and may require surgical repair.