Burning pain in 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.
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Burning pain in the hip can be caused by a number of problems. One of the more conditions is bursitis. A bursa is a fluid-filled sac that functions to cushion tendons as they rub against bone. "Bursae" is plural for "bursa."
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 trauma or excessive activity. On rare occasions, the hip bursa can become infected with bacteria. This condition is called septic bursitis. The hip bursa can also 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 three major bursae of the hip, which can both be associated with burning pain around the hip joint. The trochanteric bursa is located on the side of the hip. It is separated from the actual hip joint by bone. Trochanteric bursitis frequently causes tenderness of the outer hip. It also causes a dull, burning pain on the outer hip that is made worse with excessive walking or stair climbing.
The ischialgluteal bursa is located in the upper buttock area. and causes buttock pain. The pain sometimes occurs after prolonged sitting on hard surfaces, hence the names "weaver's bottom" and "tailor's bottom."
The iliopsoas bursa can become inflamed and cause burning pain in the groin.
With trochanteric bursitis, patients frequently notice pain in the outer hip with stair climbing or descending and tenderness in the hip when lying on the affected side.
The treatment of any bursitis depends on whether or not it involves infection. Noninfectious bursitis can be treated with ice, rest, and anti-inflammatory medications. Occasionally, aspiration of the bursa fluid using ultrasound needle guidance supplemented with steroid injection can be curative.
Patients with hip bursitis can often benefit from weight reduction, stretching exercises, and proper footwear. Sometimes physical therapy can be helpful. Generally, patients should avoid hills and stairs and direct pressure on the affected hip.
Septic bursitis is unusual in the hip bursa, but does occur. Septic bursitis requires antibiotic therapy.Surgical drainage and removal of the infected bursa sac (bursectomy) may also be necessary.
Piriformis syndrome is due to irritation of the sciatic nerve as it passes through the piriformis muscle located deep in the buttock. If the piriformis muscle is unusually tight, or if it goes into spasm, the sciatic nerve can become inflamed or irritated. Inflammation of the sciatic nerve causes burning pain in the back of the hip that can often travel down into the leg.
Since the sciatic nerve begins in the back, it can be irritated by any kind of back abnormality, such as a herniated disk. Burning pain may radiate to the hip.
A painful, burning sensation on the outer side of the thigh may mean that one of the large sensory nerves (lateral femoral cutaneous nerve) is being compressed. This condition is known as meralgia paresthetica (me-ral'-gee-a par-es-thet'-i-ka).
Signs and Symptoms
•Burning pain on the outer part of the thigh, occasionally extending to the outer side of the knee
•A tingling, or numbness in the same area
•Occasionally, aching in the groin area
•Usually unilateral (one side of the body)
Restrictive clothing and weight gain are two common reasons for pressure on the nerve. A heavy tool belt or a tight corset or girdle, along with excess weight can cause this problem.
Treatment will vary, depending on the source of the pressure. The goal is to remove the cause of the compression. This may mean avoiding the aggravating activity, losing weight, wearing loose clothing, or using a toolbox instead of wearing a tool belt. In more severe cases, a corticosteroid injection using ultrasound guidance to localize the nerve can relieve the symptoms.
Tendonitis involving the gluteus medius and gluteus minimus tendons can also cause burning pain on the outer part of the hip. The treatment is ultrasound-guided needle tenotomy supplemented with the injection of platelet-rich plasma (PRP).
Tendonitis involving the adductor tendons (the ones that bering the leg to center), can cause burning hip pain in the groin. The treatment is similar to that for gluteus medius tendinopathy.
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