A patient I’ll call Maureen came to see us the other day. She’d been having pain in her hip and back and it was causing her to lose sleep. We’ll describe it here, because Maureen’s problem is actually quite common.
Maureen’s pain was in her joint, she insisted, poking the side of her hip with a finger. Sometimes it affected the side of her thigh.
It bothered her mostly at night, but she was increasingly finding it difficult to walk without a hitch. For a 52-year-old woman, she said, it was discouraging. Would she eventually need to give up walking her dog and gardening? The disruption of her sleep each night was making her cranky and depressed.
We examined her, testing her range of motion and performing certain tests. We ordered x-rays, and then an MRI. When we’d finished our evaluation, we told her what we’d found: Trochanteric bursitis.
Pain of Bursitis can be a tough one to diagnose because the symptoms vary. Some patients have hip pain; some have back pain. For some, walking becomes a chore; other people can’t rise from a chair without pain. The pain can be sharp or a dull ache. It can radiate from the buttock down the back of the leg (which can lead to the false conclusion that it’s caused by the sciatic nerve).
I sat down with Maureen and showed her an illustration of the hip. The bursae (plural of bursa) are small sacs that fill with fluid and act as shock absorbers to protect the bones. Bursitis is an inflammation of the bursa. There are bursae throughout the body, but in Maureen’s case, it was the trochanteric bursa that was affected. This one is located on the bony point of the hip. Another bursa the iliopsoas, is located on the inside of the hip and causes pain in the groin area when it becomes inflamed.
Other Areas Can be Affected
While Maureen’s is a common problem, hips are not the only area of the body that can be afflicted with bursitis.
It also occurs in the knee, heel and elbow area. Differentiating between bursitis and other conditions that affect these joints— such as arthritis, tendinitis, tendon or ligament damage, infection, fracture or neoplasm— can make it a challenge to diagnose.
A good diagnosis, of course, is a good beginning. But the patient needs concrete information: How can I avoid worsening this condition? What is the treatment?
First, while there is no clear-cut reason why some people develop bursitis, there are some known risk factors:
- Overuse. If you perform the same action over and over again, or if you practice one sport obsessively, you are more prone to this condition.
- Trauma is another trigger. If you’ve fallen, the affected bursa may become inflamed.
- Leg length discrepancy. If one leg is significantly longer than the other, bursitis is a possible consequence.
- Rheumatoid arthritis, an auto-immune disease;
- Previous surgery can leave the bursa susceptible to irritation;
- Bone spurs can do the same: irritate the bursa and cause inflammation.
Generally, bursitis does not require surgery unless it fails to respond to conservative therapy such as:
- avoiding certain activities;
- non-steroidal anti-inflammatory medication such as Ibuprofen;
- cane or crutches when needed;
- physical therapy to stretch the hip muscles;
- heat, ice or ultrasound, depending on the stage of the bursitis;
- or, possibly, steroid injections.
Some cases respond well to other drugs that disrupt pain signals from the brain.
If all else fails, we can sometimes perform arthroscopic surgery to remove the offending bursa. This won’t affect hip mobility, and the recovery period is shorter than for open surgery.
The most important thing is to get a good diagnosis. If you’ve been troubled by hip or back pain that doesn’t seem to have a clear cause, give us a call. A good diagnosis is the beginning of a more comfortable lifestyle.