What Is Trochanteric Bursitis?

Trochanteric bursitis is inflammation and swelling of the bursa (fluid-filled sacs that cushion and protect tendons, ligaments, and muscles) in the area near where the femur (thighbone) projects outward, which is an attachment site for the gluteal muscles. Hip bursitis may result from injury, repetitive rubbing, or pressure within the hip. It is the most common cause of hip pain.

Read on to learn about the symptoms, causes, and treatment of trochanteric bursitis.

Types of Hip Bursitis

Bursae (the plural of bursa) are jelly-like sacs that contain a small amount of fluid. They help cushion against friction between bones and soft tissues in areas such as the hip, shoulder, knee, elbow, and heel.

Bursitis occurs when the bursa becomes inflamed. There are two types of hip bursitis:

• Trochanteric bursitis: occurs in the bursa that covers the greater trochanter (the bony point of the hip bone where it meets the femur)
• Bursitis of the iliopsoas bursa: occurs on the inside (groin side) of the hip

Symptoms of Trochanteric Bursitis

Most people experience pain with trochanteric bursitis.

Pain in the hip from trochanteric bursitis may:

• Feel worse getting up after sitting or lying down
• Increase with repetitive or prolonged activity, such as stair climbing, walking, sitting cross-legged, or squatting
• Occur at the point of the hip
• Extend to the outside of the thigh area
• Be sharp and intense at first, then become more of an ache
• Be worse at night
• Be worse when lying on the affected hip
• Be tender to the touch

Other symptoms of trochanteric bursitis include:

• Hip swelling
• Redness and/or warmth in the affected area
• Limited movement and weakened muscles in the area (from the bursa thickening over time)
• Limping or difficulty walking
• Joint stiffness
• A catching and clicking sensation

Bursitis flares may be acute (lasting hours or days) or chronic (lasting from a few days to a few weeks and may go away and return).

Causes of Trochanteric Bursitis

Hip bursitis can happen to anyone but is more common in women and middle-aged or older people.

Hip bursitis can happen with:

• Injuries to the hip, such as falling. banging the hip, or laying on your side too long
• Repeated pressure or overuse of the hip, such as during long periods of physical activity that work the hip joint (walking, standing, gardening, etc.)
• Other conditions that affect the spine, hips, knees, and legs, such as osteoarthritis, bone spurs or calcium deposits on the hip bone or thighbone, scoliosis, or pinched nerves
• Significantly uneven leg lengths
• Conditions such as rheumatoid arthritis, gout, pseudogout, or diabetes
• Bacterial infection
• Previous hip surgery

How Is Trochanteric Bursitis Diagnosed?

To diagnose trochanteric bursitis, your healthcare provider will start with a comprehensive physical examination. During this exam, they may:

• Ask about your symptoms and when they began
• Ask you to point out the area that hurts
• Feel around and press on your hip area
• Ask you to lie on the exam table while they move your hip and leg
• Check how your legs and hips are functioning by asking you to perform simple tasks, such as standing on the affected leg, walking, sitting down, and standing up
• Measure the length of each of your legs

Your healthcare provider may also order tests, including:

• X-rays
• Bone scans
• Magnetic resonance imaging (MRI)
• Ultrasound

These tests can help rule out other potential causes of your pain, such as fractures.

Treatment for Trochanteric Bursitis

Treatment for hip bursitis usually involves lifestyle changes and treatments to manage symptoms while the bursa heals and exercises to improve strength, flexibility, and stability.

More invasive options, such as injections or surgery, are also available if necessary.

Lifestyle Changes

Lifestyle changes that can help treat hip bursitis and help prevent it from returning include:

• Changing activities: Avoid activities that cause pain so that the bursa can heal.
• Using hip support: You can take pressure off the affected hip by using aids such as a walking cane, crutches, orthotics, or a hip brace.

With these measures, hip bursitis often improves within a few weeks.

Exercises, Physical Therapy, and Occupational Therapy

Exercises, physical therapy, and occupational therapy help treat and prevent hip bursitis by:

• Finding ways to move that relieve pain
• Strengthening hip muscles
• Strengthening core muscles to prevent overuse injury
• Increasing mobility
• Stretching muscles/improving flexibility
• Preventing muscle atrophy
  

Remember to warm up and stretch before exercising. Exercises such as swimming may strain your joints less than higher-impact ones like running.

Always check with your healthcare provider before trying these or any new exercises.

Medications

Medications may provide pain relief as your bursa heals. Medications your healthcare provider may recommend for hip bursitis include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): including Advil or Motrin (ibuprofen), Aleve (naproxen), Feldene (piroxicam), and Celebrex (celecoxib), taken for a limited period of time.
• Steroid injections: a corticosteroid injection into the bursa, with or without a local anesthetic included, may provide temporary or permanent relief. It can be repeated in a few months if the pain and inflammation return, but the number of injections should be limited to prevent damage to surrounding tissue.
• Antibiotics: Antibiotics may be necessary if the bursa becomes infected.

Procedures

In some cases, hip bursitis recovery may require the help of medical procedures. These may include:

• Aspiration: A special needle removes excess fluid from the bursa. This fluid may also undergo testing for infection.
• Platelet-rich plasma (PRP) injection: A centrifuge concentrates some of your platelets. They are then injected back into the hip to help speed healing.
• Ultrasound-guided percutaneous needle tenotomy (PNT): Guided by an ultrasound, a small needle is inserted into the skin to perform small incisions on damaged tendons.

Surgery

Surgery for hip bursitis is uncommon but sometimes necessary when other treatments are ineffective.

Hip bursitis surgery is usually performed using arthroscopy (a minimally invasive technique using tiny instruments and a small camera called an arthroscope). A small incision is made to insert the camera and allow the surgeon to see inside. The affected bursa is removed through a quarter-inch incision over the hip.

This surgery takes place on an outpatient basis, and an overnight hospital stay is typically unnecessary.

The hip can still function normally after the bursa is removed.

Coping

In addition to the treatments mentioned above, there are some things you can do at home to help manage and/or prevent hip bursitis. These may include:

• Resting your hip
• Applying ice packs to the affected area
• Using a lift or insert in your shoe if one leg is shorter than the other

If you have extra weight, losing weight may help reduce pressure on your hips and other joints. If you want to lose weight, talk to your healthcare provider or a registered dietitian to develop a healthy weight-loss program that works for you.

Summary

Trochanteric bursitis is the inflammation and swelling of the bursa in the area near where the femur (thighbone) projects outward, which is an attachment site for the gluteal muscles. It is more common in women and older adults and may result from injury or from repetitive rubbing or pressure within the hip.

Hip bursitis usually improves with lifestyle changes such as managing activities that damage the bursa, exercising, and allowing time and rest for healing. Medication may help with pain management. Some procedures, such as fluid aspiration or surgery to remove the bursa, are also available treatment options.

If you are experiencing hip pain, talk to your healthcare provider about the possibility you may have trochanteric bursitis. Though hip bursitis is painful, it is also manageable.