Before a doctor makes a diagnosis of hip bursitis he or she must rule out other common problems that could cause hip pain, including lower back problems such as spinal stenosis or degenerative disc disease, as well as hip osteoarthritis, osteonecrosis, a stress fracture, a tumor, or an infection.
To identify the root cause of hip pain, a doctor will use some or all of the diagnostic approaches described below:
Patient interview. A doctor will ask a patient about medical history and to describe the onset of his or her symptoms, the pattern of pain and other symptoms, and how symptoms affect lifestyle. A patient's reported symptoms are important to diagnosis and treatment.
Physical exam. A doctor will examine the patient's joint, noting swelling, tenderness and pain points. The doctor will probably use a series of physical tests, such as asking the patient to stand on one leg.
X rays and MRI. A doctor may order an x-ray to determine if a stress fracture or osteoarthritis is at the root of the hip pain. An MRI will provide a detailed view of the soft tissue and detect abnormalities such as a swollen bursa or damaged tendon.
Aspiration and lab tests. Septic hip bursitis, in which the bursa is infected by a microorganism, is not common but it does occur. If septic hip bursitis is suspected, a doctor may perform an aspiration, removing fluid from the bursa with a needle and syringe.
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In addition to relieving pressure and making the patient more comfortable, it provides a fluid sample that can be analyzed for infection using the tests below.
- Gram stain. A lab test called a Gram stain is used to determine if certain troublesome bacteria are present. Not all bacteria can be identified with a gram stain, however, so even if the test comes back negative, septic bursitis cannot be completely ruled out.
- White blood cell count. An elevated number of white blood cells in the bursa’s synovial fluid indicates an infection.
- Glucose levels test. Glucose levels that are significantly lower than normal may indicate infection.
Occasionally lab tests to detect infection are negative even when an infection is present. Therefore, a doctor who suspects septic bursitis may prescribe antibiotics without definitive positive lab tests.