I have a very tender and painful point along the side of my hip. My doctor thinks I have hip bursitis but nothing showed up on the X-ray or MRI. Is there some other way to figure out what's going on?
Hip bursitis can be difficult to diagnose accurately in some patients. Often there is really more than one problem going on. Osteoarthritis, bursitis, and tendon pathology can all occur at the same time with overlapping signs and symptoms.
Some experts say that bursitis never occurs alone. They believe bursitis is just one of several problems that occur together. In fact, they suggest that bursitis is a sign that tendon and joint degeneration are occurring.
And to make matters even more confusing, many people with bursitis don't have any symptoms. So finding reliable test measures and symptoms to confirm a diagnosis of hip bursitis can be a challenge.
As you have discovered, sometimes bursitis shows up on an MRI, but not always. Pain with palpation over the greater trochanter may be the most reliable clinical sign of bursitis. The greater trochanter is a large bump that can be felt along the side of your hip. Large and important muscles connect to the greater trochanter.
The bursa is designed to provide a buffer or cushion between the tendons of muscles and the attachment of the tendons to the bones. Overuse or misalignment of the gluteal muscles can cause irritation and inflammation of the bursa. The end-result may be painful and persistent bursitis.
Sometimes a trial and error process is required to figure out exactly what soft tissue structures are getting pinched or pushed. When tests aren't clear as to the problem, then treatment may be started. The diagnosis is made after a specific treatment is successful.
Stephanie J. Woodley, BPhty, MSc, PhD, et al. Lateral Hip Pain: Findings From Magnetic Resonance Imaging and Clinical Examination. In Journal of Orthopaedic & Sports Physical Therapy. June 2008. Vol. 38. No. 6. Pp. 313-328.
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