Video presented by Ana Bracilovic, MD
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Hip Bursitis is a general term that can describe bursitis coming from a few different areas. Bursitis specifically means inflammation of the fluid pocket that is surrounding the hip joint. Hip bursitis can occur in and of itself, but more often occurs associated with some other symptoms.
Most often hip bursitis is reflective of an underlying pathology in the lower back. Again, the usual pathway of pain begins when the nerves in the lower spine are slightly irritated. When those nerves are not feeding the muscles as well as they can, those muscles don’t do a good job of feeding the hip joint and the neighboring bursa. Hip bursitis is usually the presentation of something that is more underlying and typically does not occur in and of itself.
Hip Bursitis Symptoms, Causes, and Diagnosis
The type of bursitis that I am referring to is specifically greater trochanteric bursitis, and usually occurs along with lumbar spine pathology. Most typically that pathology is irritating the nerves that are in the lower back. The nerves of the lower back are what supply the muscles that support the hip joint. So when the underlying injuries are coming from the lower back, when those nerves in the lower back are slightly irritated and there is inflammation around those nerves, then those nerves don’t do as good a job of feeding the muscles that are supporting the hip joint and the bursitis begins.
During the diagnosis of hip bursitis, the patient will have on physical examination palpable point tenderness over the greater trochanteric bursa, so you just point to the place over the trochanteric bursa and that tends to be painful. Again, it’s good when you do the physical examination to also assess the lower back, the strength of the muscles in the lower extremities, the sensation, reflexes, the normal physical exam, and to see if there’s any associated underlying lumbar pathology.
Hip Bursitis Treatments
In treating the pain and inflammation of hip bursitis, the most specific approach is to put a little bit of steroid medication and lidocaine (which is an anesthetic) right into the area surrounding the bursa. That reduces the inflammation in that area. The injection serves to reduce the swelling and take away the pain that acutely is there. In addition to that, the injection is just a window of opportunity to start good physical therapy and exercises that will start to take away the pressure off the hip joints and start making the muscles work.
When we address the underlying nerves that are irritated, and then strengthen the muscles that are supporting that hip joint, that typically will be sufficient to take care of the bursitis. The physical therapy focuses on the muscles and the support structure of the hip joint. Improving your biomechanics and making sure that there is a balanced support of the hip joints, stretching out the muscles that tend to be tight.
When hip bursitis presents in younger individuals such as athletes who are exercising a lot, they tend to have tighter hip flexor muscles which can prevent appropriate biomechanics in the lower extremities and in the back. Stretching and strengthening the hip flexor muscles and hip extensor muscles is crucial to treating hip osteoarthritis. In addition to physical therapy, chiropractic and osteopathic manipulations can also be helpful, particularly to release the restricted range of motion that’s often seen in the hip joint.
What are the Other Types of Hip Bursitis?
The most common type of hip bursitis is greater trochanteric hip bursitis. Iliopsoas bursitis is also a common form. Iliopsoas bursitis comes often associated with tendinitis and irritation of the main flexor tendon, the iliopsoas tendon. Treatment for this is similar to treatment for greater trochanteric hip bursitis. Using the ultrasound, we can nicely localize both the iliopsoas tendon and the bursa, and inject a little bit of steroid medication and anesthetic into that area to reduce the underlying swelling and inflammation. Following the injection, once a person’s pain and inflammation have improved, then physical therapy really is the mainstay of doing good exercises that will stabilize the hip joint, and stretch and strengthen the muscles that are supporting the hip joint.