Hip Bursitis Diagnosis

Called the great mimicker, hip bursitis symptoms can be mistaken for symptoms of other conditions. To diagnose hip bursitis, a doctor must rule out other problems that could cause outer hip pain, such as hip osteoarthritis, tendonitis, snapping hip syndrome, iliotibial band syndrome, and conditions affecting the low back.

To identify the root cause of hip pain, a doctor will use a combination of diagnostic tools.

Medical Visit

A physician or other licensed medical care provider can conduct a:

• 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.
• Physical exam. A doctor will examine the patient's joint, noting swelling, tenderness, and pain points. The doctor will also use a series of physical tests, such as asking the patient to move the leg out and away from the body (abduction) and in and across the body’s midline (adduction).

A diagnosis may be made at the medical exam, or additional diagnostic tests may be ordered.

Medical Imaging

If it is unclear whether symptoms are caused by hip bursitis or another condition, a doctor may request an:

• X ray. The most common type of medical imaging ordered is x-ray. X-rays can help determine if a stress fracture or osteoarthritis is at the root of the hip pain.
• Magnetic Resonance Imaging (MRI). An MRI is not necessary to diagnose hip bursitis, but may be ordered to confirm or rule out possible diagnoses. An MRI will provide a detailed view of the soft tissue and detect abnormalities such as a swollen bursa or damaged tendon.
• Ultrasound. Similar to MRI, ultrasound is not necessary to diagnose hip bursitis. An ultrasound can detect areas of fluid, such as the excess synovial fluid found in a swollen bursa.

Medical imaging cannot determine if the hip bursitis is caused by an infection (septic bursitis).

Aspiration and Lab Tests

A doctor may recommend the inflamed bursa be aspirated, particularly if he or she suspects the bursa is infected. During aspiration, fluid is removed from the hip’s bursa with a needle and syringe.

An aspiration procedure is typically done with the help of medical imaging to ensure the needle is placed directly into the affected hip bursa.

Removing fluid from the inflamed bursa can:

• Relieve pressure in the hip and make the patient more comfortable
• Provide a fluid sample that can be analyzed and tested for infection

See What Is Arthrocentesis (Joint Aspiration)?

Septic hip bursitis, in which a bursa is infected by a microorganism, is not common in the hip.¹Novatnack ES, Protzman NM, Weiss CB. Primary Septic Greater Trochanteric Bursitis. J Glob Infect Dis. 2015;7(2):93–94. doi:10.4103/0974-777X.154448

See Septic Bursitis

Additional lab testing

Blood tests may also be used to rule out or confirm systemic (body-wide) inflammatory conditions, such as rheumatoid arthritis, psoriatic arthritis, and gout. These conditions can cause joint pain and swelling. They also increase the likelihood of developing bursitis, including hip bursitis.

See Diagnosis through Synovial Fluid Analysis

Once an accurate diagnosis has been made, treatment can begin.