What is a bursa?
The bursa is a small sac of synovial fluid near a joint that creates a thin cushion to reduce friction between soft tissues and prominent parts of bones, like the pointy part of the lateral hip, the elbow, or the knee. To create this cushion, the bursa sac, lined with a thin synovial membrane, fills with synovial fluid, a lubricating substance.
When the bursae become irritated and inflamed, they produce excess fluid that swells and thickens the bursae. Because the bursae are found under the skin, fat, and muscles even a slight increase in volume can create pain. This is called bursitis. Gluteus medius tendonitis, inflammation of the tendons that lay over the bursae, or partial / full-thickness gluteus medius tendon tears often accompany hip bursitis.
- Injury like a fall or direct impact on the bursa can cause it to bleed, become irritated and inflamed.
- Repetitive use that creates repeated friction can irritate and inflame the bursa. People who bike, run, or climb stairs are more likely to develop hip bursitis.
- Excessive pressure on the bursa, such as sleeping on one’s side, can irritate and inflame the bursa.
- Tears or inflammation of the gluteus medius tendon can irritate and inflamed the bursa.
- An underlying condition like rheumatoid arthritis can cause excessive friction and result in bursitis.
- Excessive weight can put excessive strain on the hip joint and increase the risk of bursitis.
Typically, symptoms develop gradually over weeks, however, the pain can be debilitating.
- Pain on the outside of the hip with focal point tenderness.
- Pain that may radiate down the entire side of the thigh toward the knee.
- Pain may radiate to the spine causing severe low back pain.
- Pain that worsens with repetitive activity or even prolonged inactivity.
- Pain with extreme motions.
The bony prominence on the side of the hip is called the greater trochanter. This is where the strong abductor tendons, gluteus medius and minimus, attach. Greater Trochanteric Pain Syndrome (GTPS) is an umbrella term describing pain on the outside of the hip, which can be due to a number of reasons such as bursitis, tendonitis, or tearing of the gluteus medius tendon.
GTPS used to be called hip bursitis, but studies showed that GTPS pain is not generally caused by an inflamed bursa. Rather, it is due to degeneration and tearing of the gluteal tendons. The clinicians at LALL Orthopedics + have published a classification system on GTPS describing the 5 different Types ranging from isolated bursitis (Type 1) to full-thickness, retracted, irreparable tearing of the Gluteus medius and minimus (Type 5). See link below: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823867/?report=reader
Tendinopathy (degeneration) and tears of the gluteus medius or minimus tendon are the primary causes of symptoms in patients with GTPS. GTPS typically affects women in their 40’s to 60’s and manifests as chronic lateral hip pain with debilitating weakness.
Chronic periodic, recurrent lateral hip, thigh, low-back and buttocks pain that is aggravated with activity and lying on the affected side. Other symptoms include morning stiffness, radiating pain, and reduced range of motion. GTPS is a common degenerative hip condition that can be debilitating.
The experts at LALL Orthopedics + must distinguish between bursitis, GTPS and hip osteoarthritis, all of which can cause lateral-sided hip pain. They will review your medical history, ask about any injuries to the hip, and conduct a comprehensive physical examination including certain clinical tests that can help with the diagnosis. Diagnostic ultrasound can reveal fluid-filled and thickened trochanteric bursa. MRI imaging may also be recommended.
The clinicians at LALL Orthopedics + will render their diagnosis and provide you with recommendations for treatment. Most cases can be successfully managed with conservative, non-surgical treatments such as physical therapy, anti-inflammatory medications, taping, therapeutic ultrasound, healing biologic interventions (platelet-rich plasma (PRP) or Stem-Cell injections), shockwave therapy, activity modification and weight reduction. Minimally-invasive, same-day surgery to remove the inflamed bursa or repair a torn tendon may be indicated should symptoms remain following a course of conservative measures.
If you have symptoms consistent with hip bursitis, schedule a hip consultation with LALL Orthopedics +. LALL Orthopedics + is led by renowned hip surgeon Dr. Ajay C. Lall. Dr. Lall is a former dual sport NCAA collegiate athlete (football and track & field), American board certified, triple fellowship-trained expert orthopedic surgeon. LALL Orthopedics + specializes in the treatment of hip bursitis.
At a Glance
Ajay C. Lall, MD, MS, FAAOS
- Board Certified – Orthopedic Surgery
- Triple Fellowship Trained
- Performs over 750 Surgeries Per Year
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