Hip Bursitis Treatment

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What is Hip Bursitis?

Hip bursitis is a condition characterised by inflammation of the bursae in the hip region. Bursae are small, jelly-like sacs filled with fluid, positioned between bones and soft tissues. They serve as cushions to reduce friction during movement.

Types of Hip Bursitis

Hip bursitis can be divided into two primary types:

Trochanteric Bursitis

This involves the inflammation of the bursa located around the greater trochanter of the thigh bone, on the outside of the hip. The greater trochanter is a bony prominence that can be easily identified as it protrudes at the side of the hip.

Iliopsoas Bursitis

This type of bursitis affects the iliopsoas bursa, which is situated next to the iliopsoas muscle/tendon on the inside of the hip. The iliopsoas muscle helps the hip bend and facilitates various movements.

Causes of Hip Bursitis

Hip bursitis can arise from a variety of causes, each contributing to the inflammation of the bursae.


  • Repetitive Stress Injury: Engaging in activities that involve repetitive movements, such as running, stair climbing, cycling, or prolonged standing, can lead to hip bursitis. These repetitive actions can irritate the hip bursa over time.
  • Direct Hip Injury: Trauma to the hip, such as falling onto the hip, bumping it, or lying on one side for extended periods, can provoke inflammation in the hip bursae.
  • Hip or Spine Disease: Diseases affecting the hip or spine, like arthritis or scoliosis, can lead to hip bursitis. These conditions alter the normal biomechanics of the hip and can increase stress on the bursae.
  • Leg-Length Inequality: A disparity in leg length can affect walking patterns, leading to added stress on the hip bursa, potentially causing irritation and inflammation.
  • Rheumatoid Arthritis: Individuals with rheumatoid arthritis are more susceptible to inflammation, including in the bursae, thereby increasing the likelihood of developing hip bursitis.
  • Previous Surgery: Surgical procedures around the hip or the insertion of prosthetic implants can irritate the bursa, resulting in hip bursitis.
  • Bone Spurs or Calcium Deposits: The development of bone spurs or calcium deposits within the tendons attached to the trochanter can irritate the bursa, causing inflammation.

Symptoms and Signs

The primary symptom of hip bursitis is pain at the hip’s point, typically on the outer thigh or inner hip, correlating with the location of the inflamed bursa. The nature of this pain can range from sharp and intense in the early stages to a more widespread, aching sensation as the condition progresses.

Activities such as prolonged walking, climbing stairs, or squatting can aggravate the pain associated with hip bursitis. Pain can also be worse at night, disrupting sleep and rest.

Limitations in movement are another symptom. As the condition advances, the pain and discomfort from hip bursitis can lead to a decrease in the range of motion and general mobility in the hip, impacting daily activities.

Diagnosis

The process of diagnosing hip bursitis involves a combination of clinical assessment and imaging techniques, enabling accurate identification and differentiation from other hip-related conditions.

Medical Evaluation

The hip specialist will first assess the patient’s medical history and evaluate any symptoms the patient experiences.

Physical Examination

The hip specialist will conduct a thorough physical examination, focusing on identifying tenderness in specific areas of the hip. Diagnosis is typically confirmed at this step.

Imaging Tests

While hip bursitis can often be diagnosed based on clinical examination alone, additional imaging tests may be required in certain cases. An X-ray, MRI or ultrasound can help rule out bone-related causes of hip pain and look at the affected area in more detail.

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Non-Surgical Treatment Options

Non-surgical treatments typically suffice in managing hip bursitis, with most individuals experiencing improvement with these conservative approaches. They focus on alleviating symptoms and addressing the underlying causes.

  • Activity Modification
    In the early stages, the hip specialist may suggest adjusting activities that exacerbate hip bursitis. This may involve reducing or temporarily stopping activities like running or climbing that put stress on the hip.
  • Assistive Devices
    The hip specialist may also recommend using devices such as a walking stick to offload stress from the hip. This can provide relief during the healing process.
  • Nonsteroidal Anti-Inflammatory Medications
    These medications can be effective in reducing pain and inflammation associated with hip bursitis.
  • Physical Therapy
    A targeted physical therapy regimen put together by the hip specialist can stretch and strengthen the muscles around the hip, reducing inflammation and preventing recurrence.
  • Steroid Injections
    In cases where inflammation is persistent, a steroid injection directly into the bursa can provide rapid relief. This is often done under ultrasound guidance for precision.

Surgical Treatment Options

In rare cases where non-surgical treatments for hip bursitis do not yield sufficient relief or if hip bursitis recurs frequently, surgical options may be considered. The primary surgical treatment is:

Endoscopic Bursectomy

This is a minimally invasive, keyhole procedure designed to remove the inflamed bursa. It directly addresses the problem by removing the source of inflammation.

The use of small incisions and specialised instruments results in less tissue damage and scarring. As a day surgery procedure, it also allows for a quicker return to normal activities.

Prevention Strategies

Preventing hip bursitis involves a combination of lifestyle adjustments and physical activities that reduce the risk of developing this condition.


  • Maintain Flexibility and Strength of the Hips: Regular exercises like yoga or pilates can enhance flexibility and strengthen the muscles around the hips. Strengthening the core and leg muscles also helps in maintaining a stable gait.
  • Maintain a Healthy Weight to Reduce Strain on the Hips: Keeping a healthy weight reduces stress on the hips and other joints, thereby lowering the risk of bursitis. A balanced diet and regular exercise are key to achieving and maintaining a healthy weight.
  • Using Correct Techniques to Prevent Hip Injury: Adhering to the rules and guidelines of any sport or physical activity helps prevent injuries, including hip bursitis. Train under a coach or trainer, especially for beginners.
  • Wearing Supportive Footwear to Avoid Stress on the Hips: Wearing shoes that provide proper support and cushioning can prevent imbalances and excessive stress on the hips. For individuals with leg-length discrepancies, customised shoe inserts may be recommended.
  • Avoid Sudden Strenuous Activities: When starting or resuming an athletic activity, gradually increasing the intensity helps avoid putting sudden strain on the hips. Incremental training programs are beneficial for this purpose.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed

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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    How Long Does Recovery from Hip Bursitis Take?

    Recovery time varies depending on the treatment approach. Conservative treatments, such as rest, physical therapy, and medication, may take several weeks to a few months to recover. If surgical intervention is required, recovery typically takes around 6 weeks, depending on the surgery’s extent and the patient’s overall health​​.

    What Happens to Hip Bursitis if It Goes Untreated?

    Untreated hip bursitis can lead to worsening symptoms and potential complications. Persistent inflammation might cause the bursa to thicken, potentially leading to mobility issues, muscle atrophy, and even arthritis​​. Reach out to us for personalised care to avoid these complications.

    What Activities Should I Avoid with Hip Bursitis?

    Avoid activities that exacerbate hip pain, such as prolonged walking, stair climbing, or repetitive hip movements. Modifying activities to reduce stress on the hip can be beneficial.

    Should You Massage Hip Bursitis?

    While gentle massages may provide some relief, consult with our hip specialist to determine the most suitable approach for your condition.

    How Should I Sleep with Hip Bursitis?

    To minimise discomfort while sleeping, avoid lying on the affected side. Using a pillow between the legs can help maintain alignment and reduce stress on the hip.