Burning and a degenerative hip

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.

Click here: Second Opinion Arthritis Treatment Kit

Burning and a degenerative hip is a common problem. let's talk about what some of the more frequent causes.

A bursa is a fluid-filled sac that functions as both a gliding surface to reduce friction between tendons and joints and as a shock absorber. 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 burning pain around the hip joint.

The trochanteric bursa is located on the side of the hip. It is separated from the hip joint by tissue and bone. Trochanteric bursitis causes tenderness on the outer part of the hip. It hurts to lie on the involved side. It also causes a dull, burning pain on the outer hip that is made worse with walking or stair climbing. Patients often experience pain when getting up from a seated position, but feel better after moving around a little bit.

The ischial bursa is located in the buttock area and that is where pain is felt most acutely. It can cause dull pain in this area that is most noticeable when 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 is infected. Aseptic (non septic)hip bursitis can be treated with ice, 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, using ultrasound guidance. 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 done at the same time as the aspiration procedure.

Septic bursitis requires antibiotic therapy, often given intravenously. Repeated aspiration of the inflamed fluid may be required. Surgical drainage and removal of the infected bursa sac (bursectomy) may be necessary.

Osteoarthritis (OA) is due to degeneration of articular cartilage, which is the connective tissue that lines the ends of the bones inside the joint. Cartilage absorbs shock and allows movement of the joints. When OA develops, cartilage wears away. Adjacent bone hypertrophies. There may be changes in the synovial membrane, a thin tissue that lines the capsule surrounding the joint. Bony spurs, called osteophytes, may develop as well.

Osteoarthritis of the hip can cause 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 a limp.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.

Low back osteoarthritis can cause lumbar radiculopathy (pinched nerves) which can cause burning uncomfortable pain that is oftened referred to the hip region.

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. Occasionally, patients will have degenerative hip disease at the same time and this combination may cause confusion in diagnosis.

A treatment program will depend on the diagnosis. It should have the following goals: easing pain and discomfort, reducing or preventing disability, and helping continue usual activities as independently as possible. Most programs begin with a combination of medicine plus exercise and rest. Medicine can be very helpful in reducing pain.

Regular exercise helps strengthen the muscles that support the joints. The stronger those muscles are, the less pain.

First line treatment for osteoarthritis of the ip includes modification of activity and use of anti-inflammatory medicines. Glucocorticoid injections may also help. Newer stem cell techniques can postpone the need for surgery.

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