Hip (Trochanteric) Bursitis

CONDITION

Bursae are fluid-filled sacs that serve to reduce friction between tissues that cross each other, such as where muscles and tendons slide across bone. When a bursa becomes inflamed, irritated or swollen it is called bursitis. Hip (trochanteric) bursitis occurs when the bursa over the outside, or lateral, hip becomes inflamed, irritated and/or swollen (Figure 1). Hip bursitis can be acute or chronic, and is a common cause of hip pain.

Figure 1.

CAUSES

Hip bursitis can result from:

• trauma such as a blow or fall to the outside (lateral) hip
• repetitive or overuse activities such as running, cycling, jumping or climbing stairs
• tight muscles and tendons around the hip, especially those affecting a broad, tendon on the outside of the hip called the iliotibial band
• loss of tissue elasticity (stretchability) with age, common in middle-aged women
• prolonged lying on the affected side
• previous hip surgery
• difference in leg length
• other conditions such as rheumatoid arthritis, gout or infection.

SYMPTOMS AND SIGNS

• You will have pain over the bony area on the outside, or lateral aspect, of your hip.
• Pain can be achy or sharp, and is often worse when lying on your side with pressure on the bursa, especially at night.
• You may notice pain radiating down the outside of your leg, but not below your knee.
• You will sometimes have swelling and warmth over the bursa, but not always.
• Your pain may be worse after certain activities (listed above) or exercise.
• You may have pain when going up or down stairs.
• Pushing on the outside of your hip over the bursa will cause pain.
• You may have pain and/or stiffness after getting up out of a chair or with movement after resting.

WHEN TO CALL YOUR DOCTOR

Call your doctor right away (night or day) if:

• You have severe pain over the outside of your hip that occurs after an injury such as a fall.
• You have so much pain that you can't walk without crutches.
• You have redness and warmth over the swollen area on the outside of your hip.
• You have numbness, tingling or loss of sensation in any part of your thigh, lower leg or foot and toes after an injury.
• You have weakness in your hip that prevents you from walking.

Call your doctor during normal business hours if:

• You have weakness in your hip that causes you to limp.
• You have pain that awakens you at night.

Call your doctor during regular office hours if any of the following symptoms continue beyond two to three weeks of trying the self care measure below:

• You have mild to moderate pain, swelling and/or bruising over the outside of your hip after an injury.
• You are having difficulty doing normal daily activities or going up stairs.
• Your injury seems to be getting worse in any way.
• Your pain is not resolving after three weeks.

SELF-CARE AT HOME

For severe injuries that require you to call your doctor right away:

• Use crutches to take the weight off your injured leg.
• Use ice packs or cold packs over the injured hip. Put the ice pack or cold pack over an elastic wrap and hold it in place with plastic wrap.
• You may take acetaminophen (Tylenol®) for discomfort. (See the label for dosing and risks.) Until you talk to your doctor, however, avoid anti-inflammatory medications such as ibuprofen (Advil®, Motrin®) because they may slightly increase the risk of bleeding into your muscle after a strain.

For injuries that do not require immediate medical attention (see above):

• Rest from all activities that cause symptoms until all your symptoms go away.
• Avoid running, jumping and kicking until your symptoms have gone away.
• Place an ice pack or cold pack over the back of your thigh over the injury for 20 minutes at a time.
  • To minimize pain, swelling and bruising, use the cold pack or ice pack every hour or two for the first 24 to 36 hours.
  • After the first day or two, use cold packs three to six times daily or more often if your symptoms demand it.
  • If you are not using an elastic wrap directly over your skin, place a thin washcloth between the cold pack and your skin to minimize the risk of frostbite. You can hold the cold pack in place with an elastic wrap.
  • If you are busy, you may choose to ice during meals so as to save time and avoid interrupting other activities.
• You may take ibuprofen (Advil®, Motrin®) or naproxen (Aleve®) for swelling and pain. (See labels for dose and risks.)
• Once your soreness starts to get better after the first few days following injury, you may start gentle stretching and strengthening exercises. Avoid aggressive stretching that causes pain because it can cause further injury to your hamstrings.
• Avoid lying on your affected side until your pain goes away.
• Perform the stretching exercises below once daily. Do each gently, two to three times. Avoid bouncing during stretching and hold stretches for 30 seconds.
  • Iliotibial Band Stretch (Figure 2): Cross your injured leg behind your other leg and lean toward the uninjured side. This stretch is best performed with your arms over your head, creating a "bow" from ankle to hand on the injured side. Avoid leaning forward or backward and try to keep your upper body in the same line (plane) as your lower body to get the best stretch.
  • Foam Roller (Figure 3): Roll the outside of your injured leg over the foam roller from your knee to your hip. Start with about two minutes and add more time gradually each day to help mobilize your tissues and break up scar tissue.