Hip bursitis: protect yourself from disability

Bursitis is an inflammatory disease that affects the joint sacs containing synovial fluid. They serve as shock absorbers during physical stress on the joints. Therefore, inflammatory processes in bursitis affect the mobility and sliding of fibers along the bone surface of the joint.

Hip bursitis affects the musculoskeletal system, affecting one of the synovial bursae. The hip joint itself contains a large number of synovial sacs with fluid, but bursitis can only affect certain ones, such as the ischial, vertical or iliopsoas.

Hip bursitis is common among professional athletes, especially long-distance runners. The danger of this inflammation is that without proper and timely treatment, the patient may lose the ability to move without assistance. And if complications occur, blood poisoning can occur, which can lead to death. In this regard, it is very important to respond in time to the first signs of bursitis and immediately seek help from a specialist.

What is joint bursitis

The bursa or joint capsule is located in those parts of the body where there is movement and shock absorption is needed. The joint capsule is a kind of pocket made of a durable outer shell and mucous tissue inside. Its task is to protect the joint from injury, increased friction of moving elements against each other and nourish the cartilage tissue of the joint, which does not have its own blood vessels. To do this, the cells of the inner layer of the bursa produce a special synovial fluid. It contains all the microelements necessary to nourish and moisturize cartilage.

The hip joint has several bursae located on the lateral side of the thigh (trochanteric) and deep within the joint are the iliopsoas and sciatic. Bursitis most often occurs in the trochanteric, ischial, or iliopsoas bursae of the hip joint.

With inflammation, the amount and composition of the lubricating fluid changes. Calcium salts appear in it, the amount of protein increases, there may be traces of blood and inflammatory elements. The fluid itself becomes larger, the joint capsule swells, causes pain and causes limited mobility in the joint.

2. Reasons

The most common cause of trochanteritis is considered to be chronic overload of the hip joint. Due to the habitual stretching of tendons, i.e., in fact, their constant traumatization with the formation of micro-tears and micro-hemorrhages in fibrous-collagen strands, a degenerative-dystrophic process starts and progresses, accompanied by a local immuno-inflammatory reaction.

The main risk factors include hypothermia, injuries (bruises, falls, compressions), excess body mass index, age-related changes in tissues and systemic metabolism, weakened immunity of any etiology (due to which the addition of a secondary infection to the initially aseptic inflammation is facilitated), osteochondrosis, osteoporosis, as well as belonging to certain professions, primarily associated with lifting and manually carrying heavy objects.

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Types of bursitis

Depending on the location where the inflammation occurs, there are:

• Trochanteric bursitis of the hip joint is a pathology in the area of ​​the outer protrusion of the pelvic bones, where pain will be felt.
• Ischial - inflammation occurs near the ischial tuberosity. Pain occurs when straightening the leg from a bent position.
• Iliopectineal - this inflammation is characterized by pain and noticeable swelling on the front surface of the thigh.

The most common form is trochanteric bursitis of the thigh (occurs up to two times more often than other types). It can bother women more often due to the anatomical features of the female pelvis - a wider pelvis leads to more intense muscle friction.

Trochanteric bursitis is often familiar to those who are professionally or actively involved in running or cycling at an amateur level, work that requires constant standing.

Depending on the nature and duration of bursitis, it can be:

• Acute - develops over several days, often as a consequence of injury. So acute trochanteric bursitis can be a consequence of falling on one side or a sharp collision (for example, hitting a table with your hip). The acute phase lasts about a month, after which, if not cured, it will become chronic.
• Chronic – a less intense and protracted inflammatory process.

There is also a difference in the reason why bursitis developed. There are:

• Specific inflammations - due to non-infectious factors - joint injuries, heavy and constant load with monotonous movements.
• Nonspecific - it is caused by infectious damage to the joint due to tuberculosis, soft tissue infections and other causes.

The composition of synovial fluid is also important for understanding the cause of the disease and principles of treatment. Based on this criterion, bursitis is divided into:

• Serous.
• Hemorrhagic - the presence of blood in the fluid.
• Purulent is the most dangerous form of acute bursitis with severe pain, rapid development and risk of complications.

Exercises for hip bursitis

To reduce the likelihood of developing bursitis, you should perform exercises aimed at strengthening the hip abductors:

1. Starting position: resting your hands on the table surface, position your body at an angle, as for push-ups. In this case, the back should be absolutely straight. Take one of your hands to the side and put it back. Do the same with the other hand. Repeat 5-10 times.
2. Starting position: standing. Bend the knee of one leg, while turning the pelvic area in the opposite direction. Then smoothly tilt your body towards your leg. Do the same with the other leg. Repeat 5 times.

Symptoms

An inflammatory process in the joint - bursitis of the hip joint is manifested by the following symptoms:

• Pain in the thigh when walking, flexing/extending the joint, lying down (especially on the sore side). The most acute pain is at the very beginning of inflammation, and as trochanteric bursitis of the hip joint becomes chronic, the symptoms gradually become less pronounced. With purulent bursitis, everything is different - as the amount of pus in the joint capsule increases, the pain becomes more severe.
• Edema - swelling (diameter can reach up to 10 cm) will be noticeable with bursitis of the trochanteric bursa or anterior. When the internal bags are inflamed, swelling is not visible.
• Impaired joint mobility due to swelling or pain.
• Redness of the skin and an increase in its temperature are not always noticeable signs.
• Symptoms of general intoxication of the body - weakness, fever.
• Inflammation of the inguinal lymph nodes.

The symptoms of hip bursitis in women and men are the same, although the disease itself occurs more often in women (especially with active running). The very moment of injury (with post-traumatic bursitis) occurs with acute and sudden pain and a click. In the future, it hurts to squat, climb stairs, or make rotational movements with your foot.

The course of the disease varies depending on the form of bursitis:

• In the acute form, there is obvious pain, a burning sensation in the joint, and an increase in temperature.
• In chronic cases, there may be no characteristic signs or the symptoms will be mild.

Diagnostic methods

The primary diagnosis is made based on the patient’s complaints, the results of an external examination, and medical history. To confirm it, a sample of synovial fluid is taken using a puncture. Its study makes it possible to determine the nature of inflammation and establish the sensitivity of microorganisms to antibiotics.

If the development of specific infections (tuberculosis, syphilis, gonorrhea) is suspected, bacteriological studies are carried out. Since the symptoms of hip bursitis can mask arthritis and coxarthrosis, instrumental examinations of the joint are prescribed:

• radiography;
• MRI, CT, ultrasound.

They are usually carried out to differentiate bursitis from other diseases and to identify inflammation of the deep-lying synovial bursa.

Causes

The main causes of hip bursitis:

• Injuries and damage to the joint and femur due to falls and impacts. The most dangerous cases of purulent and infectious bursitis are injuries with violations of the integrity of the skin.
• Heavy physical activity - standing work, running on uneven terrain, cycling and some other sports.
• Diseases of the spine and joints - arthritis, scoliosis, arthrosis and others.
• Allergies or autoimmune diseases (rheumatoid arthritis, scleroderma and others), when inflammation occurs due to the reaction of one's own immune cells.
• Deposits of calcium or uric acid salts in the joints, for example, with gout.
• Diseases and conditions in which metabolism is disrupted: diabetes mellitus, kidney disease, long-term treatment with steroid hormones.
• Performed operations on the hip joint.

Risk factors for bursitis include:

• Overweight.
• Postural disorders and body asymmetry.
• Flat feet.
• Congenital joint dysplasia.

Bursitis treatment process

With bursitis, the patient must limit any physical activity on the hip joint and avoid activities that increase pain. Neutralizing pain and preventing the development of the disease occurs with the help of non-steroidal anti-inflammatory drugs prescribed by a doctor.

Mild joint inflammation is treated on an outpatient basis and consists of a one-time injection of medications into the damaged synovial sac. If the treatment does not give the desired effect, the patient is given another injection.

Complex treatment also includes rehabilitation exercises. After stopping the inflammatory process, the patient is prescribed electrophoresis, ultrasound and therapeutic exercises. The main goal of effective treatment for bursitis is not to relieve symptoms or inflammation, but to prevent the chronic progression of the disease.

Surgical intervention is prescribed in severe cases when the standard treatment procedure does not give the expected effect. The only solution is to remove the damaged bag. The procedure includes the following steps:

1. dissection of the damaged part of the thigh;
2. installation of an arthroscope - allows the surgeon to easily remove the synovial sac;
3. direct removal of the affected sac.

The removal operation itself is characterized by a minimal risk of injury and a less painful rehabilitation process. Over time, a new sac is formed, and the properties of the joint are normalized.

Folk remedies for bursitis will help relieve inflammation, but achieving the main goal of treatment will be extremely difficult. If the treatment or recovery process is not handled properly, bursitis can become chronic, which will complicate subsequent treatment, and in the worst case, lead to complications.

Diagnostics

Treatment of hip bursitis begins with diagnosis. The doctor must make sure that it is bursitis and not another disease with similar symptoms. It is also necessary to understand the nature of inflammation - depending on the cause, different treatment will be required. Post-traumatic bursitis requires a mandatory reduction in the load on the joint, and infectious bursitis requires the use of antibiotics.

During the consultation, the doctor conducts an examination and learns in detail about the existing complaints and the characteristics of their occurrence. In addition, more accurate diagnostic methods are needed:

• Blood and synovial fluid analysis.
• X-ray to evaluate pathologies in the joint - osteophyte deposits or others.
• Ultrasound or MRI are studies that allow you to evaluate soft tissues, the processes occurring in them and blood circulation in the joint area.

Diagnosis of hip bursitis

Our clinic uses effective diagnostic methods, complemented by innovative Western developments

Diagnostics takes place in stages and includes:

1. Primary visual diagnosis. Collecting information from sources such as the patient’s behavior, gaze, appearance and breathing allows the doctor to identify the problem from the first minutes of communication.
2. Survey. The conversation with the patient is based on a certain pattern of questions that help to clarify the problems with the patient’s body at the energy level. This is called the fine-tuning technique.
3. Inspection. When examining a patient, the doctor uses a combination of Eastern and Western techniques to most fully assess his state of health, identify the root cause of the disease and hidden symptoms.
4. Pulse diagnostics. The method allows you to make an accurate diagnosis, as well as determine the risk of complications and concomitant diseases.
5. Load tests. Using this technique, the severity of the local problem is revealed.

In order to clarify the diagnosis made using Eastern techniques, traditional research methods (laboratory tests, instrumental and hardware diagnostics) are sometimes prescribed.

Treatment

Complex conservative therapy is used, which may include:

• Drug treatment of hip bursitis - depending on the symptoms, painkillers, anti-inflammatory drugs, glucocorticosteroids and antibiotics are prescribed (for purulent and infectious inflammation). Medicines can be in different forms of release, administered by injection, and their effect will be enhanced by physiotherapeutic procedures.
• Physiotherapy using various methods: laser, magnetic and ultrasound therapy, electrophoresis, galvanization, darsonvalization, procedures with interference currents and other physiotherapeutic methods at the discretion of the doctor. They improve blood circulation and lymphatic drainage in the area of ​​inflammation, provide pain relief, reduce inflammation, relax muscles and enhance the penetration and effect of drugs.
• Taping, wearing an orthosis and other methods to reduce the load and support the joint, ensure its immobility - this is especially effective for new-onset acute bursitis.
• Acupuncture (acupuncture, acupuncture) – effects on biological active points on the body.
• Therapeutic massage and manual therapy are procedures that effectively reduce pain, swelling and serve for the treatment and prevention of a wide variety of joint diseases.
• Physical therapy is a set of exercises that will speed up the healing process. They activate blood circulation and lymph flow, reduce pain and inflammation. Treatment with movement is especially important for the chronic form of the disease and prevention of relapses. Measurement is important - not every exercise will help. With bursitis that appears due to heavy physical activity, on the contrary, you need to provide rest to the joint and reduce stress. What exercises will the exercise therapy doctor recommend, and the training itself in the exercise therapy room with an instructor will be more effective and safe than independent exercise at home.
• Surgical intervention - drainage of pus from the bursa and washing of the capsule with antiseptic drugs, antibiotics, removal of the bursa in case of acute inflammation with the risk of rupture of the bursa membrane and spillage of pus into adjacent periarticular tissues. Thus, surgical treatment of trochanteric bursitis of the hip joint allows a person to return to physical activity without restrictions several months after treatment.

In general, the prognosis for the treatment of bursitis is positive - inflammation can be relieved by various methods and complications such as tissue sepsis, the formation of fistulas, the development of arthritis and osteomyelitis and other pathologies can be avoided. But much depends on the patient himself - how quickly he sought help, how he adheres to the doctor’s recommendations.

Therapy is aimed not only at relieving inflammation and improving mobility in the joint, but also at treating the cause of inflammation so that there are no relapses. It determines which doctor treats hip bursitis - only an orthopedic traumatologist or will require the participation of an immunologist and other doctors.

Bursitis (trochanteric bursitis, iliopectineal bursitis, sciatic bursitis)

The muscles that provide movement in the hip joint contract and lengthen. In this case, the muscle can rub against neighboring muscles, tendons and bones. To reduce this friction, our body has special synovial bursae (bursae) that contain fluid. In some cases, the bursa becomes inflamed, which results in pain. This disease is called bursitis (from the Latin word bursa - bag and the ending itis - inflammation). The main causes of bursitis are trauma, physical overload of tendons and muscles. The development of the disease is facilitated by hypothermia, a sedentary and sedentary lifestyle, obesity, and different leg lengths.

There are many synovial bursae around the hip joint, but mainly only three of them become inflamed:

• The trochanteric bursa (trochanteric bursitis or trochanteritis), which is located near the greater trochanter of the femur, pain is localized in the area of ​​the greater trochanter - the outer bony protrusion on the femur. Next to this bursa there is another one - subtrochanteric bursitis, but subtrochanteric bursitis has no practical significance, since in both cases the treatment is the same.
• The iliopectineal bursa (iliopectineal bursitis), which is located in front of the iliopsoas muscle. This bag is often connected to the joint cavity and its inflammation resembles coxitis, i.e. inflammation of the hip joint. Swelling and tenderness are determined along the anterior inner surface of the thigh below the inguinal ligament. Increased pain is noted when the hip is extended.
• The sciatic bursa (sciatic bursitis) is located at the site of muscle attachment to the ischial tuberosity, pain increases with hip flexion.

The most common condition is trochanteric bursitis, which is sometimes called trochanteritis. Any of the three main bursitis (trochanteric, iliopectineal or sciatic) can develop as a complication of injury or without any obvious external cause.

Diagnosis

Trochanteric bursitis is the most common condition. With this disease, there is a deep, sometimes burning pain in the hip joint, which sometimes radiates down along the outer surface of the thigh. A typical complaint is the inability to lie on a certain side due to a significant increase in pain in the hip, as well as increased pain when walking, climbing stairs, squatting and rotating the hip inward, sometimes outward. The pain decreases with rest, but can periodically intensify at night, especially when lying on the painful side.

The pain can be chronic, growing gradually over many days, or acute - in the latter case it can usually be associated with a hip bruise, for example as a result of a fall or collision with something. Some patients may note that they heard or felt a click in the hip at the time of injury.

Trochanteric bursitis is particularly common in athletes, particularly female runners: the wider female pelvis predisposes to increased soft tissue friction against the greater trochanter. Sometimes athletes are able to name the cause of pain, for example, an increase in running distance or difficulty in training. When running on the streets, often only one leg is affected due to the side slope of the outer side of the road, designed to drain water.

When examined by a doctor, pain is detected upon palpation (pressure) of the greater trochanter of the femur. Similar pain is present with gluteus medius tendinitis, but it is felt slightly higher and is triggered by active abduction of the hip, whereas pain with trochanteric bursitis is most acutely felt in the pronated and adducted position of the hip. To identify this sign, the doctor moves the patient’s leg with his hands and determines the position in which the pain is maximum.

There may be tension in the iliotibial band, as indicated by a positive Ober test (leg abduction test). It is carried out as follows. The patient is placed on his healthy side, asked to bend the lower leg at the hip joint, and the upper leg, bent at a right angle at the knee joint, is abducted and straightened at the hip joint, and then released. If the leg does not lower completely, but remains slightly abducted, this indicates tension in the iliotibial tract.

In controversial cases, additional research methods are used, but often the diagnosis is obvious after examination and additional diagnostics are not needed. X-ray examination of trochanteric bursitis may show calcifications (areas of ossification) in the periarticular soft tissues near the greater trochanter. In addition, osteophytes (bone spines) may be detected in the area of ​​the greater trochanter. A magnetic resonance imaging scan may show signs of inflammation of the trochanteric bursa and accumulation of fluid in it. It is possible to perform an ultrasound examination, which also shows the presence of excess fluid in the bag.

Treatment

For recovery, rest, exercise therapy and anti-inflammatory drugs are usually sufficient. In prolonged cases, physical therapy, glucocorticoid injections, or surgery may be required.

Treatment begins with the prescription of anti-inflammatory drugs and the elimination of movements that provoke pain. After relief of acute pain, begin stretch exercises to stretch the iliotibial tract and tensor fascia lata, and strengthen the gluteal muscles. Specific exercises depend on the type of bursitis.

If these methods do not have the desired effect, physiotherapy is prescribed, in particular electrophoresis or ultrasound therapy. If this does not help, an injection of glucocorticoids is given into the most painful area. In most cases, these methods are sufficient to cure the patient.

Widespread other physiotherapeutic methods of treatment (magnetic therapy, laser therapy, decimeter wave therapy, transcutaneous electroanalgesia, naphthalan applications) do not have any therapeutic effect for bursitis and are only an appearance of treatment, allowing you to pass the time until spontaneous remission of the disease.

It is possible that extracorporeal shock wave therapy has an effect, but there is no clear evidence of its feasibility for bursitis.

In rare cases, pain persists despite conservative treatment and serves as an indication for surgery. Several methods of surgical treatment of trochanteric bursitis have been described, which, according to published data, are quite effective even in athletes and allow them to return to sports several months after surgery.

The principle of most operations for trochanteric bursitis is to release the tension of the iliotibial tract, with or without excision of the trochanteric bursa. In general terms, the operating technique comes down to the following. A longitudinal incision is made over the greater trochanter through which the surgeon exposes the iliotibial tract, gluteus maximus, and tensor fascia lata. A longitudinal incision is then made in the iliotibial tract, under which the trochanteric bursa is located. The bursa is excised, and the tension on the iliotibial tract is relieved either by a Z-plasty or by excising an oval flap from it over the lateral epicondyle of the femur (just above the knee joint).

The prognosis for recovery is usually good.

Complications

The main complication of trochanteric bursitis is its chronicity, which may require surgery. Usually, all phenomena of trochanteric bursitis subside after a few days or weeks, but in some patients the disease takes a protracted (up to several months) or even chronic course. At the same time, the typical pain syndrome and limitation of internal rotation of the hip remain, and in the case of the development of adhesive capsulitis (inflammation of the hip joint capsule), a picture of a “frozen” hip joint is formed with the progression of its stiffness and partial or complete impairment of mobility.

Prevention

You can reduce the risk of inflammation of the joint capsule or the development of relapses using preventive measures. Effective:

• Moderate physical activity.
• A balanced diet so that the cartilage tissue receives all the necessary nutrients.
• Maintaining a normal weight - every extra kilogram increases the load on the spine and joints.
• Maintaining immunity by such methods as a daily routine, adequate sleep and rest, a balanced diet, walks in the fresh air and other measures.
• Wearing comfortable orthopedic shoes, maintaining posture.

Clinically Relevant Anatomy

A bursa is a two-membrane bursa (or sac) filled with fluid located next to a joint. It forms a cushion to minimize friction between soft tissue and bone structures, and acts as a shock absorber during muscle and joint movement.

In the case of trochanteric bursitis, two bursae are usually involved:

• The gluteus medius bursa is located above the greater trochanter and under the insertion of the gluteus medius muscle.
• The gluteus maximus bursa is located between the greater trochanter and the attachments of the gluteus medius and gluteus maximus muscles.

Treatment of bursitis at the Kuntsevo Diagnostic and Treatment Center

Specialists from the Kuntsevo Multidisciplinary Medical Center are ready to help in the diagnosis and treatment of a wide variety of diseases. We work according to the principles of personalized medicine, using innovative techniques with proven effectiveness.

The clinic has high-tech diagnostic, treatment and rehabilitation facilities. We are confident in the accuracy of the diagnoses and the effectiveness of the prescribed treatment and its results.

We work daily at the address: Moscow, st. Partizanskaya, 41. Phone for appointments and consultations: +7 (495) 480-75-77.

1.General information

Trochanteritis (synonyms “trochanteric bursitis”, “peritrochanteritis”) is a particular variant of periarthritis, i.e. inflammation of the periarticular tissues, localized in the area where the femur meets the corresponding tendons (trochanter). Inflammation can spread to the synovial bursa and tendon-ligament apparatus.

As a separate, independent nosological unit, trochanteritis was isolated and described at the end of the 19th century by the prominent French surgeon Leon Clément LeFort (1890).

Mostly people of mature age suffer, with a slight predominance of women, which is due to morphological and histological gender differences.

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Symptoms of trochanteritis

Damage to the femoral trochanters can occur on only one side or be bilateral.

The main manifestation is pain. As a rule, it appears during physical activity, walking, running. Pain sensations are located on the lateral surface of the thighs. They may subside with rest when the person is sitting or lying down. But often they can be provoked by lying on the side, since the affected joint is again subjected to stress and muscle tension.

Often other symptoms are completely absent. The hip moves normally in full range, no movements are impaired or limited. Therefore, it can be quite difficult for a doctor to make a diagnosis during an examination. The multidisciplinary CELT clinic employs specialists who can promptly suspect the disease and prescribe the correct examination and treatment.

4.Treatment

As a rule, they start with conservative therapy, the key directions of which are a gentle regimen, relief of inflammatory phenomena (the drugs of choice are non-steroidal anti-inflammatory drugs, but in case of severe pain, hormonal drugs are injected into the periarticular tissues), eradication of the pathogen in case of proven infection, analgesics according to indications, and, of course, physiotherapeutic procedures. In recent years, high-tech treatment methods, in particular shock wave therapy, have become widespread, but its feasibility and effectiveness are still a matter of debate.

Surgical intervention is a last resort and is used in isolated cases (as a rule, with acute purulent trochanteritis with the threat of serious complications).

Orthopedics and traumatology services at CELT

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Make an appointment through the application or by calling +7 +7 We work every day:

• Monday—Friday: 8.00—20.00
• Saturday: 8.00–18.00
• Sunday is a day off

The nearest metro and MCC stations to the clinic:

• Highway of Enthusiasts or Perovo
• Partisan
• Enthusiast Highway

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Types of trochanteritis

Trochanteritis occurs in several types:

• infectious or septic. It develops when the periarticular tissue is damaged by bacteria or viruses. The cause is infectious or viral diseases;
• non-infectious, aseptic. Develops as a result of excessive loads on the trochanter of the thigh;
• tuberculous trochanteritis. Soft periarticular tissues and the greater trochanter of the femur are damaged, and osteomyelitis of the femoral bone begins to develop. It belongs to a separate variant of tuberculosis, mainly affecting children.

Treatment of trochanteritis

The need for surgery for trochanteritis occurs quite rarely.

In most cases, the disease can be managed using conservative techniques, which include:

• Drug therapy. Mainly anti-inflammatory and painkillers. Local blockades are used - the introduction of drugs into the painful area. Such manipulations are performed by our Pain Clinic specialists.
• Physiotherapy. For example, laser therapy and magnetic therapy are highly effective.
• Physical therapy after eliminating inflammation and pain.

In the multidisciplinary CELT clinic, the most effective treatment program is selected for each patient, in accordance with modern schemes and individual characteristics.