Arthritis bursitis hip pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The hip joint consists of the interaction between the head of the femur and the pelvis.
Surrounding the hip joint are multiple small sacks of fluid called “bursae” which help to cushion the joint.
A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction. "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."
Garden variety bursitis 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 three major bursae of the hip, which can be associated with stiffness and pain around the hip joint. The first is the iliopsoas bursa which is located in front of the hiop joint. Patients with iliopsoas bursits have groin pain aggravated by walking, climbing stairs, and lifting their leg.
The trochanteric bursa is located on the side of the hip. Trochanteric bursitis causes tenderness of the outer hip, making it difficult for patients to lie on the involved side. It also causes a dull, burning pain on the outer hip that is often made worse with walking or stair climbing.
The ischiogluteal 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 hip pain, specific areas of tenderness on the outside of the hip, and confirmed by relief with local injection of anesthetic in the doctor's office. The doctor can localize the tender areas to the location of the bursae of the hip. Occasionally, magnetic resonance imaging 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. Diagnostic ultrasound is another useful modality.
The treatment of bursitis depends on whether or not it involves infection. Noninfectious or aseptic hip bursitis can be treated with ice compresses, rest, and anti-inflammatory 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 using ultrasound guidance. The fluid should be sent to the laboratory for further analysis. Noninfectious hip bursitis can be treated with an injection of cortisone medication, often with an anesthetic, into the swollen bursa. This is done at the same time as the aspiration procedure.
Patients with hip bursitis often benefit from weight reduction, stretching exercises, and proper footwear for exercise activities. Sometimes physical therapy programs can be helpful. Generally, patients should avoid hills and stairs while symptoms are present.
Septic bursitis is uncommon in the hip. But it does occur. The bursal fluid can be examined in the laboratory for bacteria. 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:
• Bursitis of the hip is the most common cause of hip pain.
• It commonly occurs in association with arthritis involving the hip.
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.
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