A bursa is a small flat cushion-like structure, one to three inches in size, usually found in between a muscle and a bone. It helps provide protection and less friction. It is sometimes thought of as a small fluid filled cushion, but usually it is quite flat, similar to a barely filled plastic bag of water. These are present in many areas of our skeletal system, and may cause pain around the hips, shoulders, elbows and knees.
Symptoms due to bursitis of the hip will occur when the bursa becomes injured, pinched or inflamed. When the bursa is inflamed, it is called bursitis (the ‘itis’ refers to something that is inflamed - like appendicitis). When the bursa is inflamed or injured the lining of the bursa produces more fluid causing swelling and pain.
In the hip, the main bursa is on the side of the hip. This is the most common place for hip bursitis, and often is called trochanteric bursitis. This may become painful with injury or strenuous or repetitive activities causing inflammation of the bursa in this case. If the muscle on the side of the hip is too tight and pinches down on the bursa, this will cause hip bursitis. Injuries to the side of the hip, or new activities such as prolonged walking or running may lead to hip bursitis. Calcium deposits or ‘bone spurs’ may develop on the side of the upper hip bone and also cause tendonitis in addition to bursitis. Sometimes hip bursitis is due to a more serious disease, such as rheumatoid arthritis or even infection.
If the symptoms are due to bursitis of the hip, at rest there is less pain, but it usually will feel painful with walking, pressing on the side of the hip, or lying on the hip at night. Pain may actually be felt most on the side of the upper upper leg, sometimes down almost to the knee. Pain from hip bursitis will not go below the knee. The pain may be very sharp if the bursitis is severe.
Along with a history of the hip symptoms, an examination usually suggests bursitis is present. Often X-rays are done, but because the bursa is made of soft tissue, X-rays or CT scans are often not sufficient. An MRI or ultrasound examination may show if bursitis is present.
The treatment of bursitis depends upon how severe the pain is. In general, if pain does not improve with ice and rest, then medical evaluation is a good idea. Physical therapy and anti-inflammatory medications may be tried to reduce pain. If the symptoms do not improve, X-rays, MRI or ultrasound tests may be ordered.
Various medications may be used to reduce pain. These may include over the counter medications such as Tylenol (generic = acetaminophen) Aleve (generic = naproxen), Motrin (generic = ibuprofen) or aspirin. Prescription medications which belong to a group of medications called ‘non-steroidal anti-inflammatory medications (or ‘NSAIDs’ for short) are commonly recommended. Some of the more commonly prescribed of these include medications such as Celebrex, Motrin, Naprosyn, Mobic, Voltaren, Relafen and Lodine. (a complete list is available at the reference below).
More severe pain may be treated with injections of cortisone-like medications into the bursa on the side of the hip. Rarely, surgery may be required to remove the bursa and calcium deposits.