Houston Methodist. Leading Medicine

Hip FAQ

Question:

I have spent months and months being treated for a hip problem that was finally diagnosed correctly as a hip bursitis. Why was this so hard to figure out in the first place?

Answer:

Greater trochanteric pain syndrome (GTPS), also known as hip bursitis is a common cause of hip pain. But the pain pattern it creates is very similar to many other musculoskeletal conditions. It can take some time (up to several years for some patients) for an accurate diagnosis to be made. The greater trochanter is the large bump on the outside of the upper end of the femur (thigh bone). This bump is the point where the large buttock muscles that move the hip connect to the femur. The gluteus maximus is the largest of these muscles. It attaches lower down on the femur. If you lie on a hard surface for very long, you will feel the effects on your greater trochanter. Where friction occurs between muscles, tendons, and bones, there is usually a structure called a bursa. A bursa is a thin sac of tissue that contains fluid to lubricate the area and reduce friction. The bursa is a normal structure. The body will even produce a bursa in response to friction. Sometimes a bursa can become inflamed (swollen and irritated) because of too much friction or because of an injury to the bursa. An inflamed bursa can cause pain because movement makes the structures around the bursa rub against it. Inflammation in the bursa between the tendon and the greater trochanter leads to greater trochanteric pain syndrome. This problem is common in older individuals. It may also occur in younger patients who are extremely active in exercises such as walking, running, or biking. Sometimes it isn't until the patient has gone through a long process of trial and error in treating the problem that the true source of the symptoms becomes apparent. In the case of hip bursitis, one treatment doesn't work for everyone. Some people get better with a single steroid injection into the bursa. Others require two or three injections. Some patients respond to physical therapy with stretching, strengthening, and core training. Others don't improve until issues of postural alignment are addressed with proper shoes, shoe inserts, or for some athletes, correcting training errors. There are even some patients who have surgery to remove any pieces of loose cartilage, frayed edges of the bursa, or torn tendons before the pain is relieved. And in some cases, the surgeon has to remove some of the bone that's pinching the bursa against the tendon. All-in-all, your experience is more typical than you might have guessed. With recent advances in the evaluation of patients and better understanding of the underlying anatomical cause(s) of bursitis, we hope future patients will be spared the long and drawn-out diagnostic process you experienced. Chris Dougherty, DO, and John J. Dougherty, DO. Managing and Preventing Hip Pathology in Trochanteric Pain Syndrome. In The Journal of Musculoskeletal Medicine. November 2008. Vol. 25. No. 11. Pp. 521-523.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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