Bursitis of the Hip

What is Bursitis?

A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. The major bursae (plural for bursa) are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees. When the bursa becomes inflamed, the condition is known to as “bursitis.” Most commonly, this is a non-infectious condition (aseptic bursitis) caused by inflammation resulting from local soft tissue trauma or strain injury. On rare occasions, the hip bursa can become infected with bacteria. This condition is called septic bursitis. 

What is Hip Bursitis?

There are two major bursae of the hip, which can both be associated with stiffness and pain around the hip joint.
 
The trochanteric bursa is located on the side of the hip. It is separated significantly from the actual hip joint by tissue and bone. Trochanteric bursitis frequently causes tenderness of the outer hip, making it difficult for patients to lie on the involved side. It also causes a dull, burning pain on the outer hip that is often made worse with excessive walking or stair climbing. Sufferers often experience excruciating pain when getting up from a sitting position, but feel better after moving around a little bit.
 
The ischial bursa is located in the upper buttock area. It can cause dull pain in this area that is most noticeable climbing up hill. The pain sometimes occurs after prolonged sitting on hard surfaces, hence the names “weaver’s bottom” and “tailor’s bottom.”

Treatment

The treatment of any bursitis depends on whether or not it involves infection. Aseptic hip bursitis can be treated with ice compresses, rest, anti-inflammatory and pain medications, and physical therapy. Occasionally, hip bursitis requires aspiration of the bursa fluid. This procedure involves removal of the fluid with a needle and syringe under sterile conditions. It can be performed in the doctor's office. Sometimes the fluid is sent to the laboratory for further analysis. Non infectious hip bursitis can also be treated with an injection of cortisone medication into the swollen bursa. This is sometimes done at the same time as the aspiration procedure. Generally, patients should avoid hills and stairs, when possible, while symptoms are present.
 
Septic bursitis requires even further evaluation by a doctor. This is unusual in the hip bursa, but does occur. The bursal fluid can be examined in the laboratory for the microbes causing the infection. Septic bursitis requires antibiotic therapy, often intravenously. Repeated aspiration of the inflamed fluid may be required. Surgical drainage and removal of the infected bursa sac (bursectomy) may also be necessary.