Bursae are flat, jelly-like sacs located in multiple locations throughout the body. The most well-known bursae are on the back side of the elbow and side of the hip. Bursae reduce friction where ligaments and tendons cross over the top of a bony prominence. 

Bursitis happens when there is tension and pressure placed over the bursa. The bursa becomes irritated, inflamed and can develop extra fluid and scar tissue inside the sac.

It is safe to walk with hip bursitis as it usually is an inflammatory condition that causes mild to moderate pain. If symptoms are more severe, persistent and associated with weakness, it could be related to more serious conditions — such as muscle and tendon tearing or damage. It should be evaluated by a hip specialist and may need to be addressed with injections and possibly.

Hip Bursitis Locations

There are two major bursae in the hip that typically become irritated and inflamed — trochanteric bursa and iliopsoas bursa.

Trochanteric Bursitis

The trochanteric bursa is on the side of the hip where a thick piece of tissue called the iliotibial band (IT band) runs along a bony prominence on the femur bone called the greater trochanter. When most people think of their hip joint, they think it is on theire, over the greater trochanter. This is not actually where the hip joint is located. 

The IT band can become tight due to overuse, muscle imbalance, and weakness. When the IT band becomes tight it can push on the underlying bursa and cause trochanteric bursitis. This bursa can also become irritated from a fall or lying on one side for an extended period of time. If the IT band is very tight some patients feel a painful snap across the outside of the hip during certain movements.

Iliopsoas Bursitis

This bursa is located in the front of the hip where the iliopsoas tendon crosses over the front of the hip joint. Pain is located in the groin area. This condition is not as common as trochanteric bursitis. 

Iliopsoas bursitis is commonly caused by a tight and overactive iliopsoas muscle and tendon. If the iliopsoas tendon is very tight it can sometimes cause a painful snap across the front of the hip during certain movements. The muscle and tendon can become tight due to overuse, muscle imbalance and weakness, and less commonly to stabilize the hip in patients who have hip dysplasia.

Diagnosis Hip Bursitis

Trochanteric bursitis can be easily diagnosed by a physical exam. The outside of the hip will be painful to touch. Sometimes the area will look visibly swollen.

Iliopsoas bursitis is harder to diagnose on exam. Pain that is coming from inside the hip joint will cause symptoms similar to trochanteric bursitis. Sometimes a special MRI called an MR arthrogram is ordered to help us figure out if there is something going on inside the hip joint that could be causing your pain.

Hip Bursitis Treatment

Treatment for bursitis depends on the severity of your symptoms and length of time you’ve had pain. Trochanteric bursitis almost always resolves with a course of physical therapy to stretch your IT band and strengthen your hip, back, and core muscles. When symptoms are severe, we will sometimes recommend a cortisone injection into the bursa so that you can better tolerate physical therapy. Very rarely surgery is done to take out the inflamed tissue. Surgery can be performed with either a conventional open technique or newer minimally invasive arthroscopic techniques.

Isolated iliopsoas bursitis is treated with physical therapy. Sometimes a cortisone injection is also performed to help the patient tolerate therapy. Iliopsoas bursitis is commonly associated with other hip conditions such as hip impingement, hip dysplasia or abductor dysfunction. These conditions may require further treatment if they are the source of your bursitis. Surgery for isolated iliopsoas bursitis is rarely recommended, but can be performed with minimally invasive techniques when required.

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