Treatments for Hip Bursitis
Orthopedic Patient Updates
written by Dr. Will Kurtz
What is hip bursitis?
Hip bursitis (also known as trochanteric bursitis) occurs when the Iliotibial band (ITB) rubs on the greater trochanter portion of the femoral bone.(fig. 1) Hip bursitis does not involve the hip joint and does not mean patients need a hip replacement. Often, the tensor fasciae latae (TFL) muscle is irritated and stays overly contracted which tightens up the iliotibial band. The increased tension in the ITB irritates the greater trochanter bursa and causes the hip pain.
Fig. 1 - Hip Anatomy
Symptoms
Hip bursitis usually causes lateral hip pain that is tender to push on. The pain often happens when the patient first starts to walk. Patients will often find it difficult to sleep in bed on either the affected or non-affected side. Patients will often try to sleep 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 (trendelenberg gait), then a hip MRI is appropriate to ensure that the hip abductor muscles (gluteus medius and gluteus minimus) are not damaged.
Treatment Options
Hip bursitis does not generally require surgery. The main treatments involve stretching, oral medications, injections, topical medications, massage, and physical therapy.
Physical Activities:
ITB Stretches
Physical Therapy
Foam Rollers
Massage
Dry needling
Yoga
Injection Medications:
Cortisone Injections
Toradol Injections
Platelet Injections (PRP)
Topical Medications:
Voltaren Gel
Lidocaine Patches
Menthol/Capsaicin creams
Oral Medications:
NSAIDS
Oral Steroids
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
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.
Foam Rollers
Patients can gently massage their ITB with foam rollers.
Massage
A massage gun or professional masseuse can help relax the IT Band and relieve some hip pain.
Dry Needling
Dry needling can sometimes be used be physical therapist to help alleviate hip bursitis pain, but there is not clinical evidence to support its use.
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
Cortisone/Steroids injection
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 joint 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.
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 burse. These platelets are little sacks of chemicals (growth factors and other proteins) that burst open from mechanical trauma after they are injected into a knee joint. 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 $~550 cash for a PRP shot which covers our cost of the kit used to spin down the platelets..
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, 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)
Reanl/Kidney events
Cardiovascular thrombotic events - (hypertension, heart attack, MI)
Contra-indicated while taking blood thinners (Coumadin, Xalerto, 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. Salonpas are an over the counter version of lidoderm patches. Stronger lidoderm patches are available with a prescription.
CBD / Hemp Oil
I have only heard anecdotal stories about CBD and hemp oil from other patients. I have not seen any scientific studies proving the efficacy of these agents.
Dr. Will Kurtz
Dr. Will Kurtz is a hip and knee replacement specialist. He sees patients at the TOA OneCity office on Monday afternoons, all day Wednesday, and Friday afternoons. He sees patients at the TOA Hendersonville office on Monday mornings and at the TOA Lebanon office on Friday mornings. He typically operates on Tuesdays and Thursdays.
