Arthritis bursitis hip pain
The hip joint consists of the interaction between the femur and the pelvis.
A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. "Bursae" is plural for "bursa." The major bursae 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 noninfectious 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. Also uncommonly the hip bursa can become inflamed by crystals that deposit there from gout or pseudogout.
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, frequently making sleep difficult. It also causes a dull, burning pain on the outer hip that is often made worse with excessive walking or stair climbing. 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."
Bursitis of the hip is the most common cause of hip pain. Bursitis of the hip is diagnosed based on the history of outer hip pain, specific areas of tenderness of the outside of the hip, and confirmed by relief with local injection of anesthetic in the doctor's office. Patients frequently notice pain in the outer hip with stair climbing or descending and tenderness of the hip when lying on the affected side at night. The doctor can localize the tender areas to the location of the bursae of the hip. Occasionally, x-ray tests of the hip are used to rule out other conditions of the bone and joints, such as arthritis. Sometimes, but not always, x-rays can highlight areas of calcium deposits in an inflamed bursa. Often, bursitis is associated with underlying arthritis in the hip joint.
The treatment of any bursitis depends on whether or not it involves infection. Noninfectious or aseptic hip bursitis can be treated with ice compresses, rest, and antiinflammatory and pain medications. Occasionally, it 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. Frequently there is inadequate fluid accumulation for aspiration. Noninfectious hip bursitis can be treated with an injection of cortisone medication, often with an anesthetic, into the swollen bursa. This is sometimes done at the same time as the aspiration procedure. Patients with hip bursitis can often benefit by weight reduction, stretching exercises, and proper footwear for exercise activities. Sometimes physical therapy programs can be helpful. Generally, patients should avoid hills and stairs and direct pressure on the affected hip (sleep on the other side), when possible, while symptoms are present.
Septic bursitis (again, uncommon in the hip) 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. Important Points to remember: • A bursa is a fluid-filled sac that functions as a gliding surface to reduce friction between moving tissues of the body. Percutaneous needle tenotomy with autologous tissue grafting has become a reliable method of treating chronic bursitis that hasn't responded to other measures. With this procedure, a small gauge needle is introduced into the bursa using ultrasound guidance with local anesthetic. The needle is used to punch a few small holes in the bursa to stimulate an acute inflammatory response. Then, platelet rich plasma, which is obtained from a specimen of the patient's whole blood is injected into the area. Platelets are cells that are rich in healing and growth factors. New good quality bursal tissue is stimulated to grow. For more information on tendonitis and bursitis, visit our sister site:
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