Hip Pain’s First Cousin
I see quite a bit of hip pain in my office. Some of it is truly hip pain,
and the others… well… not so much. I usually have a good
idea whether the pain is really hip pain by the answer to my first question:
“Where does your hip hurt?” The patient, almost in slow motion,
invariably points to an area around their hip. If I’m lucky, they
point to one spot instead of just waving around their index finger like
a magic wand. Now, this is a simplified diagnostic example, but if they
point to their groin, then it’s probably a hip issue. If they grab
the back of their thigh or lower back, then it could be the lumbar spine
of sacroiliac joint. If they point to the side of their hip, then their
pain is most likely caused by bursitis of the hip.
Hip bursitis isn’t technically a hip problem because it doesn’t
involve the joint, as would arthritis, loose bodies, labral tears or other
issues that can affect the joint proper. Instead, hip bursitis, known
as greater trochanteric bursitis, involves the small, jelly-like sacs
called bursa. They become irritated and inflamed, resulting in localized
pain over the bony prominence of the hip, called the greater trochanter.
This pain is initially localized to the lateral portion of the thigh,
especially when lying on that side. Typically, the pain is worse at night,
when lying on the affected hip or while getting up from a chair after
being seated for a while. It can also get worse with prolonged walking,
stair climbing or squatting.
As a doctor, I’m supposed to sympathize with my patients’ issues,
but when it comes to greater trochanteric bursitis, I can truly empathize
with my patients. It hurts, and I know first hand. I was on a scout campout
with my son (I will never run out of scout campout stories. The coyotes
in Sylvania or the raccoon sniffing my backside while in a hammock are
doozies). Anyway, I digress. My son and I were new to the campout thing.
After a long day of hiking, we set up camp. I assembled the new tent,
unwrapped the new sleeping bags and put batteries in our Coleman lantern
like a pro. Leon Leonwood Bean had nothing on me. However, I made one
critical mistake. After cooking out with everyone, singing Kumbaya and
all that, we all settled into our tents. It was at this time I realized
that an inflatable mattress pad would have been beneficial because there
was nothing between me and the uneven ground except for some waterproof
nylon and a few goose feathers. I tossed and turned all night, going from
one side to the other. By the time I saw the first glimmers of the sun,
I had given myself a terrible case of bilateral greater trochanteric bursitis.
Needless to say, I was up at the crack of dawn to break down camp, and
my son and I were the first two at the local McDonalds down the road from
the campground that morning.
Hip bursitis can affect anyone, but is more common in women and middle-aged
or elderly people.
The following risk factors have been associated with hip bursitis:
Repetitive stress (overuse) injury. Frequent walking, hiking, stair climbing and bicycling for long periods
of time causes the Gluteus muscle and iliotibial (IT) band to rub against
the greater trochanter, inflaming the bursa.
Hip Injury. An injury to the greater trochanter from a direct injury or prolonged pressure
on one side (camping) may cause hip bursitis.
Previous surgery. Surgery around the hip can irritate the bursa.
- Rheumatoid arthritis
- Weight loss
To diagnose greater trochanteric bursitis, a comprehensive exam is performed,
looking for the area of maximal tenderness and evaluating for other issues.
Additional tests are performed to rule out other injuries or conditions.
Nonsurgical treatment is the mainstay for this condition. Surgery is only indicated after failure
of conservative treatment.
Activity modification. Avoid the activities that exacerbate your symptoms.
- NSAIDs. A short course of an nonsteroidal anti-inflammatory drugs (NSAIDs)
will decrease the inflammation of the hip bursa.
Physical therapy. This is an important adjunct to treatment in order to target the underlying
cause of bursitis, increase hip strength and flexibility . Other treatments
that may be used include massage, ice, heat or ultrasound.
Steroid injection. Injection of a corticosteroid along with a local anesthetic may also be
helpful in relieving the symptoms of hip bursitis. This can be done in
the office and give either temporary or permanent relief. A second injection
may be performed a few months later if needed.
Surgery is rarely needed for hip bursitis but can be very effective for
those cases that have failed conservative treatment. Removal of the bursa
can be performed by a newer arthroscopic technique only requiring two
small (1/4 inch) incisions. A small camera, or arthroscope, is placed
under the skin through one incision while the other incision is used to
place small instruments to cut out the bursa. This surgery is less invasive
and recovery is quicker and less painful. Following surgery, a short rehab
period can be expected which may involve the use of cane or crutches for
a few days.
If your hip hurts for any reason, even after surviving a campout, come
on in and let me check it out.