Hip bursitis

At HCA UK we offer:  

• Appointments confirmed in under 24 hours
• Same-day medical imaging or scans as your appointment with your hip consultant
• Leading private orthopaedic care with access to a team of leading hip specialists  

What is hip bursitis?

Hip bursitis occurs when the fluid-filled sacs (bursae) that cushion the joint become inflamed. These cushions protect the tendons and muscles from rubbing against the bone. There are two major bursae on the hip that are prone to inflammation. One bursa covers the greater trochanter (the bony point of the hip) and the other covers the iliopsoas (the inside of the groin side of the hip). You will normally feel a dull, aching pain if a hip bursa is inflamed. In more extreme circumstances, you might even have difficulty performing everyday tasks. 

What causes hip bursitis?

Anything that causes increased load or pressure on the bursa can cause bursitis. In the hip, tendinopathy is the main reason for overload of the bursa. A functional overload (where the force/load through the tendon exceeds the relative strength of the surrounding muscles) contributes to tendinopathy.

Tendinopathy is a general term that describes tendon degeneration characterised by a combination of pain, swelling, and impaired performance. It involves the swelling (inflammation) of a tendon, which is a thick cord attaching a muscle to a bone.

Causes of functional overload include:

• Posture: Sitting at the desk in front of a monitor or driving for long periods of time can overload the hip.
• Anxiety or stress: This is known to cause tension in the neck, shoulder girdle and lower back and can alter posture, thereby overloading the hips.
• Weight gain: Weight gain of the core/abdomen creates a physical force on the hips, thereby increasing load.
• Strength: The actual strength of the low back/hip/buttock muscles may not be as strong as you would like.
• Carrying heavy loads: Wearing heavy rucksacks, handbags, carrier bags, holding laptops can cause an overload of the hip.

Which kinds of people are more likely to get hip bursitis?

Anyone can sustain hip bursitis, but it usually affects: 

• Older women: As women naturally have wider hips, there is greater potential for friction and compression of the bursae. Hip bursitis is less common in younger individuals and men.
• Those who have physical jobs: Hip bursitis is common in individuals with physical jobs as repetitive motions can cause inflammation of the bursa. For example, lifting heavy boxes puts excessive pressure on the hips. Over time, this can cause bursitis.
• Athletes: Hip bursitis is common in contact sports such as football and ice hockey due to excessive use when running. For this reason, bursitis is also common in endurance athletes such as long-distance runners.

People with arthritis, psoriasis, diabetes and thyroid diseases are also more prone to bursitis. As these conditions can lead to inflammation in the joints. Some of the most common causes of hip bursitis include:

• Repetitive strain injury: Overuse of the hip joint through running, stair climbing, cycling, heavy lifting, certain sports or even standing for extended periods
• Bone spurs or calcium deposits: If bone spurs or calcium deposits develop within the tendons, a hip bursa can become inflamed and irritated. These small bone deposits cause irritation, similar to a stone in your shoe. This irritation can cause hip bursitis if left untreated.
• Hip injuries: If you have recently had a fall or bump to the hip or sustained a sports injury. This is because falling directly onto a bursa can cause the bursa to swell.
• Spinal disease: Scoliosis, arthritis of the lower spine, and other spinal conditions that affect the way you walk. If a spine condition causes you to put more weight on one hip when doing everyday tasks (like walking or climbing stairs), eventually, the repetition can aggravate the hip bursa. 
• Rheumatoid arthritis: Hereditary conditions, such as rheumatoid arthritis, make you more susceptible to inflammation and therefore bursitis. 
• Leg length discrepancies: If you have one leg shorter than the other, this can impact the way you walk. The uneven distribution of weight can irritate the hip bursae. 
• Surgical complications: Hip surgery around your hip bone or prosthetic implants in the hip joint can lead to inflammation, causing bursitis. 

What are the different types of hip bursitis?

There are three main types of hip bursitis: 

1. Trochanteric bursitis: The trochanter is positioned at the top of the thigh bone, on the outside of the hip. Trochanteric bursitis is when one of the bursae in this area becomes inflamed. A trochanteric bursitis diagnosis normally follows pain on the outer thigh and outside of the hip. This type of bursitis is more common in athletes, those who do physical jobs or people who have recently undergone surgery.
2. Iliopsoas bursitis or ischial bursitis: Iliopsoas or ischial bursitis is where one of the bursae on the inside of the hip joint (beneath the iliopsoas muscle) is inflamed. This is characterised by pain in the groin or upper buttock. In some instances, patients can experience pain that travels down the thighs to the knees. Iliopsoas bursitis is usually most noticeable in the morning or after walking upstairs, exercising or standing up from a seated position. 
3. Septic hip bursitis: If your hip bursae are infected, this is known as septic bursitis. This usually comes with additional symptoms such as feeling sick, tired and feverish. Septic hip bursitis is a potentially dangerous condition, so see a doctor immediately. 

How is a hip bursitis diagnosis confirmed? 

Both trochanteric and iliopsoas bursitis are diagnosed during a comprehensive physical examination. During your consultation, our specialists will ask you about how and when the pain began, as well as any activities that aggravate your injury. They will then complete a thorough physical examination, looking for tenderness in the hip joint. Your consultant will do this by pressing on various spots of the hip joint. This way, they can see where the pain is located and decipher whether a specific bursa is causing your discomfort. 

As it can be hard to diagnose hip bursitis from a physical examination alone, our specialists may also order a blood test, provide an ultrasound scan during the consultation, arrange an MRI scan, or drain the bursitis and analyse any fluid aspirated. The fluid from your inflamed bursa will be sent off and tested for other conditions (for example, gout or rheumatoid arthritis) that can cause inflammation. The process of removing fluid from the hip joint (aspiration) can also help provide temporary relief from pain by relieving the pressure on the joint.

You might be asked by our hip specialists to perform simple movements to assess how your legs are functioning. For example, they might ask you to stand on one leg, if you can. 

To give you the most effective treatment plan, your consultant might recommend further tests. These might include: 

• A hip X-ray: While this won’t show you the hip bursitis itself, X-rays use electromagnetic energy beams to create images of internal tissues and bones. This can be used to rule out other conditions such as hip fractures.
• CT scan or MRI scan: These imaging methods are used to highlight any inflamed bursa that might be too deep for regular inspection.
• Ultrasound: Using high-frequency sound waves, an ultrasound will examine the internal tissues surrounding your hip, highlighting any inflammation of the hip bursa. This may be performed by the clinician during your initial consultation.

When you book an appointment with one of our specialists, you can usually get an appointment the next working day and any required imaging on the same day. If hip pain is holding you back, we are here to help you get a reliable diagnosis.

What are the treatment options for trochanteric and iliopsoas bursitis? 

Mild bursitis can go away without treatment. Simple lifestyle changes, such as avoiding activities that cause pain, using crutches and losing weight, can significantly improve bursitis as they reduce the amount of pressure going through the hip joint. For moderate to severe cases, intervention is required. 

Treatments for bursitis in your hip include: 

Physiotherapy 

For some people, the best way to provide relief from hip bursitis is by strengthening the muscles and/or increasing mobility. As part of your physiotherapy treatment for bursitis, your physiotherapist will:

• Teach you how to avoid or modify certain activities to encourage healing 
• Use heat, ice, ultrasound and electrical stimulation to reduce pain and swelling
• Recommend specific activities to improve the flexibility and strength in your hip and leg. They will usually start with passive motions to gently move the hip joint. Once you’ve had a few physio sessions, you’ll be given exercises and stretches that you can do at home.
• Help you create a phased return to work or sports 

Our team of leading physiotherapists work with our hip bursitis specialists to deliver personalised treatment and exercise plans created with your needs in mind. 

Hip bursitis injections 

Whether you have trochanteric or iliopsoas bursitis, injections might be prescribed as a treatment option. 

Often used to help athletes and adults, cortisone injections can provide relief from pain and inflammation around the joint. This minimally invasive procedure is highly effective in providing long-lasting relief from joint pain, potentially enabling you to avoid surgery. You will normally have to wait between three and seven days to notice a remarkable difference. 

Aspiration 

If your bursa is very swollen, your doctor might recommend aspiration for your hip bursitis. Aspiration involves removing extra fluid from the joint using a specialist needle. This process helps provide pain relief by removing excessive pressure from the joint. Fluid taken during the aspiration procedure can also be tested to rule out infection. 

Extracorporeal shockwave therapy (ESWT)

ESWT is an effective, non-invasive treatment of injured soft tissues, specifically tendons when an injury reaches a chronic non-healing state. 

A safe alternative to surgery or steroid and other treatment injections, ESWT is clinically proven to stimulate metabolic reactions. It activates the healing process by provoking an acute phase of healing and by stimulating enzymes involved in reducing pain, resulting in a high success rate in treating these difficult-to-treat, often chronic and painful injuries. 
 
The application of shock waves is an evidence-based, effective treatment for most tendon conditions including tendinopathies in the hip. Treating the tendon will take the load off the bursa and therefore treat the bursitis.

Platelet-rich plasma (PRP) injection

During PRP treatment, the doctor extracts the platelet-rich part of your blood and injects this into the area of your injury, increasing the local concentration of platelets and growth factors. To make sure the injection is in the right place, the needle is guided into the affected area via an ultrasound scan. 
The PRP injection aims to stimulate your body’s own ability to heal chronic conditions, including tendinopathies. Treating the tendinopathy will treat the bursitis.

Surgery 

Most people will make a full recovery with minimally invasive treatments. If you have tried other treatment options and are still experiencing hip pain, our consultants might discuss the surgical options available to you. 

During iliopsoas bursitis surgery, the orthopaedic surgeon will remove the inflamed bursa using minimally invasive keyhole surgery. You can expect a faster recovery, an improved range of motion and less damage to your body's tissue with this kind of operation.