Bursitis is inflammation of a bursa. The shoulder, elbow, hip and knee are the joints most commonly affected by bursitis. Bursitis may be mistaken for arthritis. Common causes of bursitis of the hip include injury and overuse. Treatment may include rest, painkillers and gentle exercises.
Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.
Bursitis is inflammation of the bursa. 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 tronchanteric 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. This condition is not as common as trochanteric bursitis, but is treated in a similar manner.
The main symptom of trochanteric bursitis is pain at the point of the hip. The pain usually extends to the outside of the thigh area. In the early stages, the pain is usually described as sharp and intense. Later, the pain may become more of an ache and spread across a larger area of the hip.
Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while. It also may get worse with prolonged walking, stair climbing, or squatting.
Causes of bursitis
Injury, repeated pressure and overuse are common causes of bursitis. Certain disorders (such as rheumatoid arthritis, gout and diabetes) can also contribute to its development.
A common cause of bursitis is overuse of a particular body part, especially if that activity is performed awkwardly or with considerable pressure.
Examples of work-related activities that may trigger bursitis include production-line packing and typing. Sports that can cause bursitis include jogging, tennis and squash.
Overuse injuries other than bursitis include:
- carpal tunnel syndrome – a painful disorder of the hand leading to increased pressure on the main nerve that runs through the wrist
- ganglion – a cyst on a tendon or joint capsule
- tennis elbow – inflammation of tendons surrounding the elbow joint
- tenosynovitis – inflammation of the tendons (the tough connective tissue that anchors muscle to bone)
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.
Treatment for bursitis
Treatment will depend on the cause of the bursitis. Treatment aims to alleviate the symptoms as much as possible while the healing process takes place.
Treatment options may include pain-relieving medications, cold packs, gentle mobilising exercises and rest. Anti-inflammatory medications or injections of corticosteroids may be used in cases of severe pain.
If infection is present, warmth, redness, pain and swelling will be experienced in the affected areas. Treatment with an appropriate antibiotic is necessary. If the bursitis was triggered by a particular form of overuse, it is important to avoid that activity.
Correct posture and joint protection are useful, and braces or splints can decrease the stress on the areas and support good alignment. After an acute attack, it is important to consider how recurrences can be prevented.
Long-term management of bursitis
Your doctor or physiotherapist can offer suggestions and strategies to reduce your risk of developing bursitis again.
To prevent recurrence of work-related bursitis:
- Use ergonomically-designed furniture and equipment.
- Take regular breaks.
- Do simple stretching exercises for 10 minutes every hour.
- Keep benches at waist height so that your shoulders can relax.
To prevent recurrence of sport-related bursitis:
- Warm up thoroughly by stretching and gently going through the motions of your chosen sport.
- Make sure you use good form and regularly practice strengthening and conditioning exercises that complement your particular sport.
- Cool down thoroughly with gentle, sustained stretches.
- Make sure footwear and equipment are appropriate for you.