Trochanteric bursitis is inflammation of the bursa (fluid-filled sac near a joint) at the part of the hip called the greater trochanter. When this bursa becomes irritated or inflamed, it causes pain in the hip. This is a common cause of hip pain.
There are two major bursae in the hip that typically become irritated and inflamed. One bursa covers the bony point of the hip bone called the greater trochanter. Inflammation of this bursa is called trochanteric bursitis.
Another bursa — the iliopsoas bursa — is located on the inside (groin side) of the hip. When this bursa becomes inflamed, the condition is also sometimes referred to as hip bursitis, but the pain is located in the groin area.
Causes
Hip bursitis can affect anyone, but is more common in women and middle-aged or elderly people. It is less common in younger people and in men.
The following risk factors have been associated with the development of hip bursitis.
- Repetitive stress (overuse) injury. This can occur when running, stair climbing, bicycling, or standing for long periods of time.
- Hip injury. An injury to the point of your hip can occur when you fall onto your hip, bump your hip, or lie on one side of your body for an extended period of time.
- Spine disease. This includes scoliosis, arthritis of the lumbar (lower) spine, and other spine problems.
- Leg-length inequality. When one leg is significantly shorter than the other, it affects the way you walk, and can lead to irritation of a hip bursa.
- Rheumatoid arthritis. This makes the bursa more likely to become inflamed.
- Previous surgery. Surgery around the hip or prosthetic implants in the hip can irritate the bursa and cause bursitis.
- Bone spurs or calcium deposits. These can develop within the tendons that attach muscles to the trochanter. They can irritate the bursa and cause inflammation.
- Incorrect posture. This condition can be caused by scoliosis, arthritis of the lumbar (lower) spine, and other spine problems.
Symptoms
- Hip Pain In the absence of a fall or other trauma, the pain from hip bursitis usually appears gradually.
- Hip tenderness Pressing on the skin over the outer hip typically causes pain. Similarly, lying down on the affected side and putting weight on the hip may cause a sudden and sharp increase in pain.
- Radiating pain Initially, the pain may be located primarily at the outside of the lower hip. Over time the pain may radiate down the outside of the thigh or to other points in the body, such as the lower back, buttock, or groin, and may extend down the outside of the thigh towards the knee.
- Pain that is worse with repetitive activity The pain may intensify after prolonged repetitive hip movements, such as with walking, jogging, or stair climbing.
- Pain that is worse after prolonged inactivity Most patients describe that the pain is worse after sleeping or after being seated for a while.
- Pain at extreme range of motion Some patients may experience pain during extreme rotation, hip adduction (using the hip to move the leg past the center midline of the body), or hip abduction (using the hip to move the leg away from the body).
- Swelling and skin redness (Less Common)
- Septic Hip Bursitis Symptoms People who have septic hip bursitis may have the symptoms described above and may also notice:
- Fatigue that does not seem to be related to a lack of sleep
- Fever
- Sick or fluish feeling (feeling “off”)
- Skin at the hip is warm to touch and red (less common)
Treatment
Nonsurgical Treatment
Many people with hip bursitis can experience relief with simple lifestyle changes, including:
- Activity modification. Avoid the activities that worsen symptoms.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen, naproxen, piroxicam, celecoxib, and others, may relieve pain and control inflammation.
- Assistive devices. Use of a walking cane or crutches for a week or more when needed.
- Physical therapy. Exercises like increase hip strength and flexibility.
- Steroid injection. Injection of a corticosteroid along with a local anethetic may also be helpful in relieving symptoms of hip bursitis.
Surgery Treatment
Particularly challenging cases of chronic hip bursitis may warrant surgery, such as:
- Bursectomy. In a traditional bursectomy an incision is made at the hip and the affected bursa is removed.
- Tendon repair and iliotibial (IT) band release. When the IT band is too tight or a tendon is injured it can result in friction and irritation of the trochanteric bursa. Surgery can be done to lengthen the IT band—called IT band release—or repair the injured tendon. These soft tissue corrections and repairs can reduce the unwanted friction.
- Osteotomy of the greater trochanter. Osteotomy is defined as the surgical cutting of bone. During this osteotomy procedure, a surgeon will shave off a small portion of the protruding greater trochanter bone (which is part of the femur, or thigh bone). This adjustment can reduce the friction and stress that caused the hip pain.