More often than not, when a patient is given the news that they are suffering from bursitis in the hip, they respond with something like, “Bursitis? I thought that was for “old folks!” The truth be known, bursitis happens to people of all ages.
When hip pain presents, there is a large list of possible causes, and each presents its own peculiar set of characteristic symptoms. Injury to a lumbar nerve root (nerves that exit the lumbar spine and proceed down into the hip, groin and leg) may be one possibility. Infections in the hip-joint and pelvis may also cause a patient to present with hip pain. These infections can exhibit excessive redness and heat in the area and must be treated medically. Trauma to the hip from a fall, motor vehicle accident or sudden athletic injury can cause fracture of the top of the femur (thigh bone) or the pelvis, resulting in hip pain.
Often in the case of trauma, there may be a thick, boggy-feeling swelling around the hip indicating that there is bleeding from a fractured bone or torn ligament. Tendons and muscles that begin and end in the area of the hip can be overused or injured in sports, especially in the “weekend warrior.” Avascular necrosis, a condition in which the femur head loses normal blood circulation and dies, will also generate hip pain. Osteoarthritis, which does occur in middle age and older persons, is a painful condition in which there has been a history of a previous injury which did not heal well and has left long-term damage in a joint. Osteoarthritis may occur for no apparent reason, perhaps because of a long life of overuse or even a congenital deformity. Gout, which is a condition in which there is a deposit of uric acid crystals in the joint, can created tremendous hip pain. Other arthritides classified as inflammatory arthritis may be present. Examples include rheumatoid arthritis and Reiter’s Syndrome. Having mentioned all of the above possible causes of hip pain, bursitis is the most common of all.
A bursa is a small, closed, fluid-filled sac or pouch that sits between two structures in the body to reduce friction between them. This is typically found between a tendon or muscle and a bone or ligament. With normal motion of the body, there is potential for friction to occur which would ultimately cause damage to the structures involved with that motion. It is the bursa’s function to greatly minimize that friction by providing a slippery buffer between moving parts. Bursae are found near all the large joints such as the shoulders, elbows, knees and hips. There are some 160 bursae located throughout the body, and possibly as many as 13 of them in and around the hip-joint alone.
Bursitis is a condition in which there is inflammation in the bursa. This may occur because of infection, various inflammatory arthritides (such as gout, rheumatoid arthritis, etc) and trauma. Most commonly, however, it is overuse and abnormal motion that is the cause of bursitis.
There are five bursae near the hip that seem to be the most problematic. Two of these, the trochanteric bursae, are located close to the “point” of the hip – one just above and behind the point of the hip, and one just below it. If one were to bump the side of the hip into a wall while walking in a hallway, the point of that contact would be directly on or very near these two bursae. Two other bursae are located in the front of the hip-joint area, and they provide protection from friction between the front side of the hip and its ligaments and the muscles that lift your thigh up and forward. A fifth burse lies on the back side of the hip joint, protecting the underside of the gluteus maximus (buttock) muscle from friction. Of these bursae, the trochanteric bursae present the majority of the problems.
Symptoms of hip bursitis typically include pain when direct pressure is applied on top of the bursa. The pain may be a sharp tenderness, or a deep dull ache. It may refer pain down the front, side or back of the thigh to the knee. Because of this, it is often overlooked and misdiagnosis as a lumbar spine problem. There is sometimes visible swelling over the side of the hip if the trochanteric bursae are inflamed. One of the most common complaints, however, is pain at night. Lying on the affected side can be extremely painful and will disturb sleep. Even laying on the unaffected side can cause the affected side to ache while sleeping.
In order to plan proper treatment, the structural and functional causes of the problem need to be addressed.
A good evaluation and workup of any hip pain is essential to rule out the more serious causes of pain. Once it is established that the bursa is the culprit, proper treatment can and should be very effective in getting rid of hip bursitis.