Is Hip Bursitis Still Around?

Pain along the side of the hip is still a common spot for bursitis (also known as greater trochanter pain syndrome. A large tendon passes over the bony bump on the side of the hip called the greater trochanter.

Inflammation in the bursa (a protective gel sac) between the tendon and the greater trochanter is called trochanteric bursitis or lateral hip bursitis. You can see there are many names for this problem.

Hip bursitis is common in older individuals. Women seem affected more often than men. It may also occur in younger patients who are extremely active in exercises such as walking, running, or biking.

Pain associated with this problem is often made worse by lying directly on the hip, walking, or going up stairs or steep inclines. It may not be possible to walk without a limp because of the pain. Hip motion and strength are not affected at first. But left uncorrected over time, the patient changes the way he or she moves. Then impairment of muscle function may develop.

Treatment early on can prevent this painful condition from becoming a chronic problem that might require surgery. Short-term use of nonsteroidal anti-inflammatory medications along with physical therapy may be all the person needs.

The physical therapist will correct any postural components, muscle imbalances, and help restore normal function of the affected hip muscles. The muscles involved most often include the gluteus minimus and the gluteus medius, the so-called rotator cuff muscles of the hip.

The effectiveness of conservative (nonoperative) care depends on a correct diagnosis and assessment of the severity of the underlying tendon injury. There are three types of hip rotator cuff tears that can cause lateral hip bursitis: 1) degenerative or traumatic tears seen most often in older adults, 2) nonpainful tears associated hip fractures or hip osteoarthritis, and 3) tendon avulsion (tendon is not just torn but pulled completely away from the bone).

Other causes of lateral hip pain can be hip osteoarthritis, an undetected hip fracture, nerve injury, or problem in the lumbar spine (low back) such as stenosis or spondylosis. The surgeon uses certain clinical tests (e.g., hip range-of-motion, straight leg raise) and imaging studies (e.g., X-rays, MRIs) to sort out what’s really going on in the hip.

MRIs are especially helpful in seeing the condition of the tendons and muscles and identifying partial tears from full-thickness tears and avulsion injuries of the gluteal muscles. Individuals who have had a previous total hip replacement may develop lateral hip pain from tendon avulsion, which will show up on an MRI.

What can be done about this problem? We already mentioned physical therapy and antiinflammatories. If conservative care doesn’t yield the results the patient is looking for, the surgeon may inject the area with cortisone. But if the MRI reveals a full-thickness tear or avulsion of the tendon, then surgery to repair the damage may be needed.

Studies show good results of surgical repair even after years of pain from the tendon tear. Of course, the earlier the repair, the better the results with fewer complications or problems. Unrepaired, damaged tendons often fill in with fat or scar tissue making repair more challenging.

Sometimes the surgeon comes across a gluteus muscle tear and trochanteric bursa filled with fluid at the time of a hip fracture repair or surgery to replace an arthritic hip joint. The tear will be repaired and any osteophytes (bone spurs) that have formed will be removed.

Various repair and reconstruction techniques have been used by different surgeons. Severe damage to the gluteal tendons and muscles may require more extensive surgery with transfer of a muscle flap from the largest gluteus (buttock) muscle, the gluteus maximus.

In all cases of chronic, painful lateral hip bursitis, the goals are to reduce pain, improve walking, and even allow the patient to get rid of any walking aids (cane, crutches, walker).

In summary, tears of the gluteal tendons of the hip leading to hip pain are fairly uncommon. But the surgeon evaluating older women with hip pain along the side must consider lateral hip bursitis as a possible diagnosis. Early diagnosis (confirmed by MRI) and treatment (whether conservative or surgical) gives the best results. Patients can expect improvement in their pain but may not regain full strength.