Hip Bursitis and Tendinitis
What is hip bursitis and tendinitis?
Hip bursitis and/or tendinitis, also known as trochanteric bursitis and hip abductor tendinopathy, may cause of lateral (side) hip pain.
A bursa is a fluid filled sac that sits between a bony prominence and soft tissues. When it becomes inflamed due to a variety of causes (see below), this may lead to the development of bursitis. In the case of trochanteric bursitis, the trochanteric bursa that sits between the trochanter of the femur (bony prominence) and the gluteus medius and minimus (hip abductor) tendons (soft tissues) becomes inflamed and painful. Alternatively, if a tendon is injured or inflamed, the initial term for this condition is tendinitis. Beyond a few weeks, the inflammatory response settles down; however, the more chronic changes at the level of a tendon are then termed tendinosis. The overarching term for tendinitis or tendinosis is tendinopathy. The tendons of gluteus medius and minimus (hip abductors) attach to the trochanter. Due to a variety of causes (see below), these tendons may become inflamed, injured, and degenerate, leading to hip abductor tendinopathy.
When a patient has concurrent trochanteric bursitis and hip abductor tendinopathy, this results in greater trochanteric pain syndrome.
What causes hip bursitis and tendinitis?
The following factors may increase risk of developing hip bursitis and tendinitis: focal injury to the lateral (side) hip, overuse injuries (e.g. prolonged walking or running), prior hip surgeries, or altered biomechanics and/or gait (walking pattern) due to poor posture, scoliosis, spine or hip issues, or leg length discrepancies.
How is hip bursitis and tendinitis diagnosed?
Patients with hip bursitis and tendinitis (trochanteric bursitis and hip abductor tendinopathy) typically present with lateral (side) hip, thigh, or buttock pain that is worsened with walking, transitioning from sitting to standing, walking upstairs, or laying on the affected side. Physical examination may demonstrate elicitation of pain with palpation of the affected regions and painful hip range of motion. X-ray, computed tomography (CT), or magnetic resonance imaging (MRI) may aid in ruling out other potential sources of hip pain such as arthritis, femoroacetabular impingement, or labral tears. Ultrasound or MRI may be useful in identifying bursitis and/or tendinopathy. Finally, a diagnostic injection of local anesthetic into the painful region may help delineate between intra-articular and extra-articular hip pathology.
How is hip bursitis and tendinitis treated?
Initial treatment options for management of hip bursitis and tendinitis (trochanteric bursitis and hip abductor tendinopathy) may include medications and physical therapy. Physical therapy should primarily focus on multi-planar hip, gluteal, and core strength and stability. If a patient is still experiencing significant pain despite the aforementioned treatment options, interventional options may include corticosteroid or platelet rich plasma (PRP) injections.
Trochanteric Bursa Injection
Using ultrasound, a needle is carefully and precisely guided to the trochanteric bursa as well as the painful tendons. Then, a steroid solution is instilled through the needle and coats the painful structures. This helps to decrease inflammation and, subsequently, decreases pain and improves function.
Platelet Rich Plasma (PRP)
PRP is component of the patient’s own blood. It is rich in growth factors and other cells that signal an increased healing response to a damaged tissue. It is used to treat a variety of painful spine and musculoskeletal conditions.
Blood is drawn from a patient and then placed in a centrifuge for it to be “spun down.” This causes the different components of the blood to separate out in the vial. The PRP solution is then drawn up into a syringe and prepared to be injected at the site of the patient’s injury.
Discontinue use of all non-steroidal anti-inflammatory drugs (NSAIDs) at least 7 days prior to the procedure. These may include ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam (Mobic), diclofenac (Voltaren), indomethacin (Indocin), and celecoxib (Celebrex). If you are taking oral corticosteroids such as prednisone or a Medrol Dosepak, please discuss this with Dr. Best prior to your procedure. In some cases, Dr. Best may request that the corticosteroid medication be discontinued in preparation for the PRP injection. Do NOT stop aspirin unless specifically instructed by Dr. Best. Depending which body part is injected, you may need a driver to and from your procedure. If you have any questions or concerns about whether to continue or discontinue any of your medications leading up to your PRP injection, please discuss these issues with Dr. Best and his team.
Once the PRP solution is created, the patient is positioned for the procedure. The skin is thoroughly cleaned and the target for the injection obtained with ultrasound or fluoroscopy (x-ray). Then, a numbing solution is injected at the skin and subcutaneous tissues for increased procedural comfort. Finally, under ultrasound or fluoroscopic (x-ray) guidance, the needle is guided to the injury site and the PRP solution is deposited.
It is common to experience mild to moderate pain or discomfort during the initial 0-3 days after the PRP procedure. Post-procedure pain can be easily managed with acetaminophen (Tylenol) or other non-NSAID pain medication. Try to avoid applying ice or heat to the injection site.
During the 3–14-day period after the PRP injection, you may gradually increase physical activity. Please continue to avoid use of NSAIDs; however, ice may be applied for short periods of time throughout the day to aid in management of post-procedure soreness/discomfort if present
During the 2–4-week period after the PRP, Dr. Best may recommend initiation of a course of physical therapy to aid in recovery and optimization of healing. The patient may begin to note improvement in pain during this time period, though it often takes 1 month or more for the benefits of PRP to take hold.
At this time, PRP injections are not typically covered by any insurance companies. Pricing and payment options can be discussed with Dr. Best and his team prior to your procedure.
As an alternative to PRP injections, trochanteric bursa injections with corticosteroid can be performed to help alleviate hip region pain. Using ultrasound, a needle is carefully and precisely guided to the trochanteric bursa as well as the painful tendons. Then, a steroid solution is instilled through the needle and coats the painful structures. This helps to decrease inflammation and, subsequently, decreases pain and improves function.
At a Glance
Dr. Craig Best
- Harvard Fellowship-Trained Interventional Spine & Sports Medicine Specialist
- Double Board-Certified in Physical Medicnie & Rehabilitation and Pain Medicine
- Assistant Professor of Physical Medicine & Rehabilitation and Orthopedic Surgery
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