Hip Bursitis

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KEY POINTS

• Hip pain is most common on the outer side of the hip, and usually affects only one hip. It is more common in women.
• You need to change or stop doing the activities that cause pain until the hip pain has healed. Treatment may include rehabilitation exercises, medicine, or surgery.
• To help prevent hip pain, wear protective pads in sports that may cause hits or falls on your hip. If your legs are different lengths, ask your provider if you should get lifts for your shoes.

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What is hip pain?

Hip pain is pain on the outer side of one hip. It may be felt when standing on one leg, when lying on that side, or when touched. It usually affects only one hip. Hip pain may be related to:

• Bursitis (irritation and swelling of a a fluid-filled sac, called a bursa) that acts as a cushion between bone and skin, muscle, tendons, or ligaments. Tendons are strong bands of tissue that attach muscle to bone. Ligaments are strong bands of tissue that connect one bone to another to form the joints.
• Swelling and irritation of tendons that connect the muscles in your hip to your leg bones
• Muscle strain of the hip abductor muscles that allow you to move your legs to the side

Hip pain is also called greater trochanteric pain syndrome (GTPS).

What is the cause?

Common causes of hip pain include:

• Injury to your hip, for example, from a fall or sudden twisting
• Overuse injuries of your hip during sports, work, or hobbies. For example, a strong band of tissue called the iliotibial band goes down the outside of your thigh and connects your hip to your knee. Tight muscles in your hips or outer thigh can tighten this band and cause it to rub against the bursa. This is more likely to happen if you run, walk, or ride a bicycle a lot, especially if you increase your mileage too fast.
• Infection from a cut or a scrape on the skin over a bursa

Other possible causes or risk factors include:

• Differences in the length of your legs or frequently running on uneven surfaces
• Arthritis, which is pain and swelling of a joint, such as the joints in your lower back
• Gout or pseudogout, which is pain and swelling caused by a buildup of crystals in your joints and under your skin
• An autoimmune disease, such as rheumatoid arthritis or lupus, which causes your body to mistakenly attack your own tissue

What are the symptoms?

Symptoms may include:

• Pain on the upper outer area of your thigh or on the side of your hip
• Pain that gets worse when you walk, bicycle, go up or down stairs, or put pressure on the side of your hip (this pain can make sleeping on your side difficult)
• Stiffness or trouble moving your hip, especially moving your leg to the side

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• An ultrasound, which uses sound waves to show pictures of the joint
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the joint
• X-rays
• Blood tests

How is it treated?

To relieve symptoms:

• You may need to change or stop doing the activities that cause pain until the bursa, tendon, or muscles have healed. Do not put any pressure on the sore area while it is swollen. For example, you may need to swim instead of running or bicycling. If you are a cyclist, you may need to lower your bicycle seat.
• Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the area every 3 to 4 hours for up to 20 minutes at a time to help relieve pain.
• Take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
  • Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.
• You will be given exercises to strengthen and stretch your hip muscles and improve range of motion. Follow your provider’s instructions for doing these exercises.

If you keep having symptoms:

• Your provider may inject the inflamed area with a steroid medicine and a local anesthetic so you will have less swelling, redness, and pain.
• Your provider may recommend surgery.

Follow the full course of treatment prescribed by your healthcare provider. Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent hip pain?

It may help prevent hip pain if you warm up properly and do stretching exercises before sports or other physical activities. You may need to cut back on or avoid doing whatever seems to have caused the pain. Wear protective pads in sports that may cause hits or falls on your hip. If your legs are different lengths, ask your provider if you should get lifts for your shoes.