Burning and a degenerative hip
A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. The major bursae (plural for bursa) 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 non-infectious 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.
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. It also causes a dull, burning pain on the outer hip that is often made worse with excessive walking or stair climbing. Sufferers often experience excruciating pain when getting up from a sitting position, but feel better after moving around a little bit.
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”.
The treatment of any bursitis depends on whether or not it involves infection. Aseptic hip bursitis can be treated with ice compresses, rest, and anti-inflammatory 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. Non infectious hip bursitis can also be treated with an injection of cortisone medication into the swollen bursa. This is sometimes done at the same time as the aspiration procedure. Generally, patients should avoid hills and stairs, when possible, while symptoms are present.
Septic bursitis 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.
Osteoarthritis (OA) is most commonly marked by degeneration of the cartilage, which is the resilient connective tissue that lines the ends of the bones and forms the surface of the joint. Normal cartilage absorbs shock (which might otherwise injure the hard bones) and allows movement of the joints along its smooth, slightly lubricated surface. In addition to cartilage damage, the bone may enlarge (called hypertrophy) at the ends, and there may be some changes in the synovial membrane, a thin tissue that lines the capsule surrounding the joint. Abnormal projections of bone, called osteophytes, may develop as well.
The joints most commonly affected by osteoarthritis include knees, the smaller joints of the fingers, the hips, the joints of the big toes, and those of the lower part of the spine.
Low back osteoarthritis can cause lumbar radiculopathy (pinched nerves) which can cause many types of pain ranging from sharp shooting pains to burning uncomfortable pain. The degeneration of the joint may occur as a result of injury or trauma to the joint, rheumatoid arthritis, occupational overuse, obesity, or metabolic diseases. Sometimes a pinched nerve near the front of the hip can cause burning pain. An example is meralgia paresthetica. This is entrapment of the lateral femoral cutaneous nerve. Sometimes patients will have degenerative hip disease at the same time and this combination may cause confusion in diagnosis.
OA is the most common form of arthritis. It may first appear without symptoms between 20 and 30 years of age and is present in almost everyone by the age of 70. Symptoms generally appear in middle age. Both men and women are equally affected by osteoarthritis, which is also called degenerative joint disease (DJD). However, under age 45, the prevalence of osteoarthritis is greater among men, where over age 55, the prevalence is greater for women. Approximately 40 out of 100 people are affected.
Symptoms: • Gradual and subtle onset of deep aching joint pain
Your particular treatment program will also depend on which and how many of your joints are affected, how far the disease has progressed, and what you want to do and can do. Your program will be individualized — that is, tailored specifically for you. It may not be the same as someone else’s. You and your doctor will work together at finding the right combination for you, so be sure to say something if you think any part of the plan is not helping. Changes can be made. You may want help from others, too, such as a nurse or physical therapist. Talk about these possibilities with your doctor.
First line treatment includes modification of activity and use of an anti-inflammatory medicine. Sensitivity of the stomach and intestines many times makes prolonged use of the anti-imflammatory medicines difficult. When the condition becomes particularly severe, then surgery is indicated. Osteoarthritis of the hip develops slowly and often involves both sides of the body. Men are more frequently afflicted than women. Osteoarthritis of the hip can cause insidious pain in the groin or inguinal region and, on occasion, pain in the side of the buttock or upper thigh. The pain is more of an aching than a burning. Often, osteoarthritis of the hip can cause you to walk with a limp. You will find that the pain is aggravated when you are moving, and relieved when you rest. Proper gait training, walking aids, and medication can be very effective in controlling symptoms.
This condition may require surgery. The most common procedure is Total Hip Replacement which aims at resurfacing both the cup (acetabulum) and ball (femoral head) surfaces. A frequent misconception of patients is that they are too old for this type of surgery since it is extensive. However, the vast majority of patients undergoing hip replacement surgery are easily within the retirement age group and usually do excellently.
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