Hip Bursitis
Thank you for coming into clinic clinic date to discuss your hip pain. These instructions may help you get some relief from your hip bursitis.
What is hip bursitis?
Hip bursitis (also known as trochanteric bursitis, lateral hip pain, or gluteal tendinopathy) occurs when the Iliotibial band (ITB) rubs on the greater trochanter portion of the femoral bone and damages the hip abductor tendons (gluteus minimus and gluteus medius). The tensor fasciae latae (TFL) muscle is the top part of the ITB and controls the tension in the ITB. Consistent, increased contraction from the TFL tightens the ITB, which in turn irritates the greater trochanter bursa, damages the abductor tendons, and causes the hip pain.
Hip bursitis does not involve the hip joint and does not mean patients need a hip replacement. Hip bursitis is more accurately described as a tendinopathy than an inflammatory condition. Hip bursitis is commonly seen in chronic back pain disorders.
Symptoms
Hip bursitis usually causes lateral hip pain that is tender to touch. The pain often happens when the patient first starts to walk or when something presses on the lateral side of the hip. Patients will often find it difficult to lay on the affected hip while sleeping. Patients usually are most comfortable sleeping on the non-affected side with a pillow between their legs.
Diagnostic test
Most patients will get an x-ray to make sure their pain is not from hip arthritis or a stress fracture. The diagnosis of hip bursitis is confirmed by point tenderness over the trochanteric bursa and x-rays that do not show hip arthritis. If patients have prolonged hip pain and/or a profound limp from abductor weakness/gluteal tendinopathy (trendelenberg gait), then a hip MRI is appropriate to ensure that the hip abductor muscles (gluteus medius and gluteus minimus) are not damaged or torn.
Treatment Options
Hip bursitis does not require surgery. The main treatments involves physical modalities, oral medications, injections, and topical medications.
Physical Activities:
ITB Stretches
Physical Therapy
Foam Rollers
Massage
Dry needling
Yoga
Oral Medications:
NSAIDS
Oral Steroids
Injection Medications:
Cortisone Injections
Toradol Injections
Platelet Injections (PRP)
Topical Medications:
Voltaren Gel
Lidocaine Patches
Menthol/Capsaicin creams
Physical Activities
IlioTibial Band (ITB) Stretches
Iliotibial stretching can be achieved with the runner’s stretch which involves pulling your knee on the affected side to the opposite shoulder. If the patient has right hip bursitis, they should try to pull their right knee to their left shoulder and position their left arm in front of their right leg. Hold that position for 10 seconds. Try to do this stretch 2-3 times a day.
Fig. 2 - Stretch for right hip bursitis - Runner’s Stretch
There are multiple videos on YouTube that demonstrate other stretches.
Physical Therapy
Physical therapist can help some patients stretch their iliotibial band. Steve Loyd, TOA physical therapist, demonstrates some hip stretches in the video below.
Massage
Patients can gently massage their ITB using a foam roller.
A massage gun or professional masseuse can help relax the IT Band and relieve some hip pain.
Yoga
Yoga helps maintain flexibility and balance. The gentle nature of yoga means is it safe for most patient to try. As always, please seek expert advice when trying something exercises and positions.
Injections
Platelet Rich Plasma (PRP) injection
Platelet Rich Plasma (PRP) shots involve taking blood out of your arm, separating the platelets from the red blood cells, and injecting the platelets into your hip bursa. These platelets are little sacks of chemicals (growth factors and other proteins) that burst open from mechanical trauma after they are injected into the hip bursa. They may relieve pain for 2-3 months, but don’t work for everyone.
Insurance does not typically cover the cost of these shots. TOA charges patients $~750 cash for a PRP shot which covers our cost of our materials used to spin down the platelets.
Cortisone/Steroids injection
Because hip bursitis is more accurately a gluteal tendinopathy than an inflammatory problem, cortisone shots can help with the pain, but probably not heal your hip bursitis.
Cortisone refers to a family of 4-5 different steroids (Depomedrol, Celestone, Methylprednisolone, Triamcinolone, or Kenalog). Steroids are tiny lipophilic molecules that can go through cell membranes, enter the nucleus of the cell, and shut off the production of inflammatory proteins and cytokines like IL-1, TNF-alpha, etc.
Because cortisone can move around cells, a small portion of the medicine can enter the capillaries around the hip and be transported throughout your body.
The therapeutic benefit from a cortisone shot usually occurs in a day or two and will last from a few weeks to maybe 2-3 months.
Diabetics may see a slight bump in the glucose levels and some patients report an increase in their appetite. Patients with dark skin will occasionally see a slight lightening of their skin color around the injection site.
Patients can get a cortisone shot every 2-3 months for hip bursitis as long as the shots are affective.
Insurance does not require a prior authorization to get a cortisone shot because these shots are inexpensive.
Toradol injection
Toradol is an injectable NSAID that can relief hip bursitis pain. It works within a few hours but only last a few days. I often include Toradol when I do a cortisone shot.
Oral Medications
NSAIDs
NSAIDs can be used to treat hip bursitis. Many patients will begin taking NSAIDs before seeing an orthopedic surgeon.
Many NSAIDS are available over the counter like:
Naproxen (Aleve)
Ibuprofen (Advil, Motrin)
Some NSAIDS require a prescription like:
Diclofenac
Etoladac
Meloxicam (Mobic),
Celecoxib (Celebrex)
There are four potential complications of any NSAIDs that patients should consider before taking NSAIDS on a regular basis. The likelihood of having a complication goes up with dosage and duration of the treatment.
Gastrointestinal events - (gastric ulcers, GI bleed)
Renal/Kidney events
Cardiovascular thrombotic events - (hypertension, heart attack, MI)
Contra-indicated while taking blood thinners (Coumadin, Xarelto, Eliquis, etc.)
If you have any of the above issues, please consult your PCP before routinely taking NSAIDs.
Steroids
Oral steroids (Prednisone) can alleviate bursitis pain but can also elevated your blood sugars, weaken your immune system, and weaken your bones if taken for prolonged periods of time.
Topical Medications
Voltaren Gel
Voltaren Gel is a topical NSAID that is available in grocery stores and on Amazon. Voltaren is a good option for patients who want to use a NSAID but have stomach ulcers or take a blood thinner.
Capsaicin / Menthol Cream
Capsaicin is the active ingredient in chili powder and causes vasodilation which makes our skin get warmer. Capsaicin may also help block some pain nerves. Menthol causes vasoconstriction which makes our skin get cooler. Icy Hot, Bengay, and Biofreeze are examples of these sorts of creams.
Lidocaine patches
Lidocaine patches are a modest way to relief hip bursitis pain. Stronger lidoderm patches are available with a prescription.
Dr. Kurtz's clinic locations and times
You can schedule an appointment online using the link below or call our TOA scheduling numbers.
615-329-6600
855-633-3862
If you need to be seen for an urgent matter and there are no available clinic times, please call Kristie at 615-963-1437, so she can overbook you.
OneCity
8 City Blvd
Nashville, TN
Monday 1-4
Wednesday 1-4
Directions
Hendersonville
501 Saundersville Rd.
Hendersonville, TN
Monday 8-11:30
Directions
Brentwood
134 Franklin Rd.
Brentwood, TN
Wednesday 8-11:30
Directions
Lebanon
1035 South Hartmann Dr.
Lebanon, TN
Friday 8-11:30
Directions
Contact us
If you have a question about your hip bursitis or suggestions about how we can improve this educational material, please contact us.
Sincerely,
Will Kurtz, M.D.