burning pain in hip

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a 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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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. When bursitis develops, it may cause a burning pain in the hip. Bursitis of the hip is the most common cause of hip pain.

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 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.

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 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. 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.

Piriformis syndrome refers to irritation of the sciatic nerve as it passes through the piriformis muscle located deep in the buttock. Inflammation of the sciatic nerve, called sciatica, causes burning pain in the back of the hip that can often travel down into the leg.

The piriformis muscle is located deep in the buttock and pelvis, and allows you to rotate your thigh outward. The sciatic nerve travels from your back into your leg by passing through the piriformis muscle. If the piriformis muscle is unusually tight, or if it goes into spasm, the sciatic nerve can become inflamed or irritated. Piriformis syndrome may also be related to intense downhill running.

You will have pain deep in your buttock that may feel like a burning pain. The pain usually travels down across your lower thigh. Your pain may increase when you move your thigh outward, such as when you are sitting cross-legged.

Your doctor will talk to you about when your symptoms began. Since your sciatic nerve begins in the back, it can be irritated by a back injury, such as a herniated disk. Your doctor will ask if you have had any injuries to your back or hip. He or she will examine your back to see if the sciatic nerve is irritated there. He or she will examine your hip and legs, and move them to see if movement causes increased pain. Your doctor may order x-rays, a computed tomography scan (CT), or a magnetic resonance image (MRI) of your back to see if there is a back injury. There are no x-ray tests that can detect if the nerve is being irritated at the piriformis muscle.

The nerves in your body bring information to the brain about the environment (sensory nerves) and messages from the brain to activate muscles (motor nerves). To do this, nerves must pass over, under, around and through your joints, bones, and muscles. Usually, there is enough room to permit easy passage. But swelling, trauma, or pressure can narrow these openings and squeeze the nerve. When that happens, pain, paralysis, or other dysfunction may result.

A painful, burning sensation on the outer side of the thigh may mean that one of the large sensory nerves (lateral femoral cutaneous nerve) to your legs is being compressed. This condition is known as meralgia paresthetica (me-ral'-gee-a par-es-thet'-i-ka).

Signs and Symptoms

� Pain on the outer side of the thigh, occasionally extending to the outer side of the knee
� A burning sensation, tingling, or numbness in the same area
� Occasionally, aching in the groin area or pain spreading across the buttocks
� Usually only on one side of the body
� Usually more sensitive to light touch than to firm pressure

Diagnosis

During a physical examination, your physician will ask about recent surgeries, injury to the hip, or repetitive activities that could irritate the nerve. He or she will also check for any sensory differences between the affected leg and your other leg. To verify the site of the burning pain, the physician will put some pressure on the nerve to reproduce the sensation. You may need both an abdominal and a pelvic examination to exclude any problems in those areas.

X-rays will help identify any bone abnormalities that might be putting pressure on the nerve. If your physician suspects that a growth such as a tumor is the source of the pressure, you may need to get an MRI or CT (computed tomography) scan. In rare cases, a nerve conduction study may be advised.

Restrictive clothing and weight gain are two common reasons for pressure on a nerve. Your physician may ask if you wear a heavy tool belt at work or if you consistently wear a tight corset or girdle. He or she may recommend a weight loss program.

Treatment

Treatments will vary, depending on the source of the pressure. It may take time for the burning pain to stop and, in some cases, numbness will persist despite treatment. The goal is to remove the cause of the compression. This may mean resting from an aggravating activity, losing weight, wearing loose clothing, or using a toolbox instead of wearing a tool belt. In more severe cases, your physician may give you an injection of a corticosteroid preparation to reduce inflammation. This generally relieves the symptoms for some time. In rare cases, surgery is needed to release the nerve.

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Burning pain in hip