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Hip Bursitis
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is Hip Bursitis?
Hip bursitis is a medical condition characterised by inflammation of the bursa, a small, fluid-filled sac that acts as a cushion between bones, tendons, and muscles near the joints. The hip joint, being one of the largest in the body, contains several such bursae, but the one most commonly associated with bursitis is the trochanteric bursa. This bursa is located on the outer part of the hip, known as the greater trochanter.
Bursitis typically results from either repetitive movements or direct impact, leading to irritation and inflammation of the bursa. While the condition can affect individuals of any age, it is more commonly observed in adults, especially middle-aged and elderly populations.
Types of Hip Bursitis
Trochanteric Bursitis
This is the most common form of hip bursitis, where inflammation occurs in the bursa covering the greater trochanter, the bony point of the hip. It often results from repetitive stress, direct trauma, or conditions like arthritis. Symptoms typically include pain and tenderness at the outer hip, possibly radiating down the thigh.
Iliopsoas Bursitis
This less common type affects the bursa near the iliopsoas muscle inside the hip, often associated with repeated hip flexion or direct pressure to the area. Symptoms include pain in the groyne region, which may extend to the front of the thigh.
Causes of Hip Bursitis
The development of hip bursitis is typically linked to a variety of factors, each contributing to the irritation and inflammation of the bursa. Some of the most common causes include:
- Repetitive Stress or Overuse
Activities that involve repetitive movements, such as running, cycling, or standing for long periods, can lead to overuse of the hip joint. This repeated stress can cause inflammation in the bursae. - Injury or Trauma
A direct blow to the hip, such as from a fall or bump, can cause the bursa to swell and become inflamed. This type of injury-induced bursitis may occur more suddenly than other forms. - Prolonged Pressure
Sitting or lying in one position for an extended period can exert continuous pressure on the bursa, leading to inflammation. - Certain Medical Conditions
Rheumatoid arthritis, osteoarthritis, and gout are conditions that can cause inflammation in various parts of the body, including the bursae. In some cases, an infection may also lead to septic bursitis. - Postural Issues and Bone Spurs
Abnormalities in posture or the presence of bone spurs near the hip joint can increase the risk of developing bursitis. These irregularities can create more friction and pressure on the bursae. - Age and Lifestyle Factors
The risk of developing hip bursitis increases with age. Additionally, certain lifestyle factors such as obesity and poor physical conditioning can contribute to the condition.
Symptoms
The symptoms of hip bursitis can vary in intensity and duration, but commonly include:
- Localised Pain
The most prominent symptom is pain at the point of the hip. This pain may initially be sharp and intense, especially during activities such as walking, climbing stairs, or after prolonged sitting. - Tenderness and Swelling
The area over the affected bursa may be tender to touch and can appear swollen or red. - Radiating Pain
In some cases, the pain can spread along the thigh or into the groyne area. - Stiffness
The hip joint may feel stiff, particularly in the morning or after periods of inactivity. - Limited Range of Motion
Movement of the hip may be restricted due to pain and stiffness, affecting daily activities. - Pain that Worsens with Repetitive Activities
Activities that put pressure on the hip bursa, such as running or climbing stairs, can exacerbate the pain.
Diagnosis
Diagnosing hip bursitis typically involves a combination of clinical evaluation and diagnostic tests:
- Medical History and Physical Examination
The initial step in diagnosing hip bursitis is a thorough medical history and physical examination. The orthopaedic surgeon will inquire about symptoms, their onset, and any activities or incidents that may have contributed to the condition. During the physical examination, the surgeon will assess the hip for tenderness, swelling, and range of motion. - Imaging Tests
To confirm the diagnosis and rule out other possible causes of hip pain, imaging tests such as X-rays, ultrasound, or MRI (Magnetic Resonance Imaging) may be recommended. While X-rays cannot show bursitis, they can rule out bone-related problems. Ultrasound and MRI are more effective in visualising soft tissue structures like the bursa. - Laboratory Tests
In cases where infection is suspected (septic bursitis), the surgeon may perform a bursa fluid aspiration. This procedure involves extracting a small amount of fluid from the bursa for laboratory analysis to detect any presence of bacteria. - Differential Diagnosis
It is crucial to differentiate hip bursitis from other conditions that can cause similar symptoms, such as hip osteoarthritis, tendinitis, or lower back problems. This differentiation is essential for selecting the appropriate treatment.
Non-Surgical Treatment Options
Non-surgical treatments are often effective in managing the symptoms of hip bursitis. These options focus on reducing pain and inflammation and improving hip function:
- Rest and Activity Modification: Limiting activities that worsen symptoms is crucial. Rest allows the inflamed bursa to heal, reducing pain and swelling.
- Physical Therapy: A physical therapist can develop a personalised exercise program to strengthen the muscles around the hip and improve flexibility, which can help reduce the stress on the bursa.
- Ice Therapy: Applying ice to the affected area can help reduce inflammation and pain, especially after activities that exacerbate symptoms.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications such as ibuprofen or naproxen can help relieve pain and decrease inflammation.
- Corticosteroid Injections: In cases where symptoms are severe or do not respond to other treatments, a doctor may recommend a corticosteroid injection into the bursa to quickly reduce inflammation and pain.
- Assistive Devices: Using walking aids like canes or crutches can help reduce the load on the hip, easing symptoms.
- Weight Management: For overweight individuals, weight loss can significantly reduce the stress on the hip joint and bursae.
Surgical Treatment Options
Surgical intervention for hip bursitis is considered only when non-surgical treatments fail to provide relief. Surgery for hip bursitis is relatively rare but can be an option in chronic cases. The main surgical procedure is bursectomy, which involves:
Bursectomy: This is a surgical procedure to remove the inflamed bursa. The surgery can be performed through a traditional open approach or using minimally invasive techniques such as arthroscopy. During the procedure, the surgeon makes small incisions near the hip and removes the affected bursa, aiming to alleviate pain and restore mobility.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
Post-Surgical Care
- Physical Therapy
Rehabilitation exercises post-surgery are essential to restore strength and flexibility in the hip. - Activity Modification
Gradual return to regular activities is advised, with careful monitoring to avoid aggravating the hip. - Pain Management
Pain and inflammation following surgery are usually managed with medications and, if necessary, ice therapy.
Preventive Measures
Preventing hip bursitis involves strategies to reduce the risk of developing the condition or to prevent recurrence after treatment. Key measures include:
Regular Exercise
Engaging in regular physical activity helps strengthen the muscles around the hip, improving stability and reducing the risk of injuries that can lead to bursitis.
Proper Technique in Sports and Activities
Using correct form and technique during sports and physical activities can help minimise stress on the hip joint.
Ergonomic Adjustments
Making ergonomic adjustments at work and home, especially if one’s routine involves prolonged sitting or standing, can reduce strain on the hips.
Adequate Rest
Allowing sufficient time for rest and recovery between intense physical activities helps prevent overuse injuries.
Maintaining a Healthy Weight
Excess body weight puts additional pressure on the hips, so maintaining a healthy weight can help reduce the risk of bursitis.
Stretching Exercises
Regular stretching can improve flexibility and range of motion in the hip, decreasing the likelihood of bursa irritation.
Wearing Proper Footwear
Shoes that provide good support can help maintain proper posture and alignment, reducing stress on the hip joint.
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Frequently Asked Questions (FAQs)
What are the Main Symptoms of Hip Bursitis?
The primary symptoms of hip bursitis include pain at the outside of the hip, tenderness, and sometimes swelling. This pain typically worsens with activities such as walking or climbing stairs.
Can Hip Bursitis Go Away on Its Own?
In many cases, hip bursitis can resolve with proper rest, physical therapy, and home treatments like ice and over-the-counter pain relievers. However, some cases may require more advanced treatment, especially if symptoms persist.
How Long Does It Take to Recover from Hip Bursitis?
The recovery time for hip bursitis varies depending on the severity of the condition and the treatment approach. It can range from a few weeks to several months, with most individuals experiencing gradual improvement.
Is Exercise Good for Hip Bursitis?
Specific exercises can help strengthen the muscles around the hip and improve flexibility, which can alleviate the symptoms of bursitis. It’s important, however, to avoid activities that worsen the pain and to follow a tailored exercise plan.