Bursitis of the hip

Synonyms

bursitis

General

The term "bursitis" refers to a disease in which it comes to inflammatory processes within one or more bursae of the joints.

The bursitis is mainly caused by injuries, infections or permanent irritation of the tissue.
Bursae are a part of every real joint. Typically, they are between two fixed joint portions which are mutually displaceable.
In the case of the hip, the bursa lies between the head of the femur (lat. Femur) and the socket of the hip bone.

The function of a bursa is to evenly distribute the pressure exerted by the individual joint structures and to facilitate the sliding of cartilage and bone together. A bursa is lined with a membrane and surrounded by a resistant capsule. The capsule of a bursal is partially permeable. In this way, nutrients from the bloodstream can penetrate through the capsule into the bursa and ensure its supply. Bursitis is particularly common in the area of ​​the elbow or knee joint. The emergence of bursitis on the hip, however, is comparatively rare.

The affected patients already notice early pain in the area of ​​the hip joint and the groin in the presence of bursitis on the hip. The pain caused by the inflammatory processes can be localized in the hip region or radiate to the lower back and thighs. In addition, the symptoms of bursitis on the hip typically increase significantly under exercise.

Definition / Introduction

The clinical picture of a bursitis of the hip is an inflammation of the so-called bursa lying over the large rolling hill. This is an anatomical structure that lies above the hip-related portion of the femur.
There are many places in the body where these bursae are found. A bursa is a bag filled with a fluid that occurs near joints, where most pressure is present. The bursa at these sites ensures that the mechanical pressure and friction from other structures naturally occurring by movement there is not transmitted directly to the musculoskeletal system, but is somewhat alleviated by the bursa.
Due to the increased mechanical stress in these areas, however, bursitis is more common. When such inflammation affects the bursa above the femur in the area of ​​the hillock, this is referred to medically as the trochanteric bursitis.
A peculiar feature of the bursae on the hip is that muscles are found in the immediate vicinity of heavily used muscles. The biceps can be irritated by the hip muscles, which are heavily loaded in some sports, and the clinical picture of bursitis can develop.

causes

The locally permeable capsule of the bursa ensures above all the supply of nutrients which can diffuse out of the bloodstream into the bursa. The less sealed portions of the bursa capsule, however, can also infect pathogens and promote the development of inflammatory processes in the bursa.
As a rule, the causative agents responsible for the development of bursitis on the hip originate from a focal point of infection which is located elsewhere in the body. Patients who suffer from a compromised immune system or who can not treat infections promptly and in a targeted manner can spread these pathogens further.
Especially viral and bacterial pathogens can easily enter the bloodstream and settle elsewhere in the body. In this way, the causative agents are also transported to the hip and can penetrate through the smallest tissue defects in the bursa. Within the bursa, these pathogens can colonize, multiply and initiate inflammatory processes. As a result, it comes to the formation of bursitis on the hip.

As a rule, the presence of such bursitis on the hip is first perceived by the affected patients themselves. Due to the deep location of the bursa of the hip, the typical inflammatory features (such as redness and swelling) on ​​the body surface can hardly be observed. Another cause of bursitis is persistent pressure overload in the affected joint. The direct cause in this context are persistent and / or recurrent movements. For this reason, especially athletes (for example cross-country skiers) are affected by inflammatory processes in the area of ​​the bursa.

In addition, external injuries can be the cause of bursitis on the hip.In this context, one distinguishes between two different forms:

  • The bursa may fill with blood and ignite due to direct violence (for example, a hitting the hip)
  • An open hip injury can cause bacterial pathogens to enter the joint and cause bursitis on the hip.

Jogging and bursitis of the hip

A particularly high risk compared to the remaining population to develop a bursitis on the hip, have joggers and amateur runners. These often expose their hip joints to certain over- or under-loading, which can lead to bursitis. The bursa serves as a kind of buffer that is designed to distribute the pressure and friction of the joint evenly across the tendons, bones, muscles and skin. So the joint apparatus should be spared and smooth movements are possible. In most cases, bursitis is caused by minor injuries or excessive pressure on the bursa. Furthermore, in runners often the bursa of the Achilles tendon is at risk for bursitis, since when rolling and pushing the foot high forces act on these.

symptoms

Bursitis of the hip often causes severe pain

Patients suffering from bursitis typically experience few symptoms at the beginning of the disease.
Occasionally the affected patients report a burning or slightly rubbing sensation. If the hips affected by the bursitis continue to be stressed, the symptoms usually increase rapidly in intensity.

Typical symptoms of bursitis on the hip are severe pain that is mainly provoked by pressure.
In addition, marked signs of warming of the skin surface are noticeable in the region of the affected hip, especially in the case of pronounced disease progression.
Visible redness develops in the case of bursitis of the hip in most cases only very late. The reason for this is the fact that the structures of the hip joint are very deep and are covered by strong muscle layers and subcutaneous fatty tissue.
In addition, swelling in the presence of bursitis of the hip are perceived until quite late. However, if fluid retention occurs around the affected hip, significant swelling usually develops.
Since the inflammatory processes lead to an increase in the volume of the bursa, the normal range of motion of the hip joint is also significantly reduced. In particular, the extensibility and rotation of the inflamed hip is shown to be inhibited early in most patients. In some cases, the bursitis in the hip even spreads to the surrounding tissue. This can lead to significant redness of the adjacent extremities.
In addition, pronounced general symptoms can be caused in the case of particularly pronounced disease progression. The affected patients often develop increasing fatigue, fatigue and fever. Since bursitis on the hip is often a bacterial infection, swelling of the regional lymph nodes can also occur.

Is it dangerous?

Most bursitis is sterile, meaning that it has not been triggered by the invasion of pathogens, such as bacteria or viruses, but rather is due to an overuse or overload of the joint. These are harmless and heal completely, with sparing of the joint and symptom-oriented therapy within a few weeks. It is advised to analgesics and cooling of the joint.

A bursitis trochanterica can also be triggered by pathogenic germs that have either been swept through the blood stream from another part of the body or have penetrated from the outside through an open injury in the joint. Since the bursa capsule is not particularly dense, it is not difficult for the pathogens to overcome them and cause inflammation. In this case, in addition to the relief and the cooling of the joint, a pathogen-adapted drug therapy for elimination is required to cause an annealing. If this form of inflammation is not discovered disproportionately treated, the risk of chronicity is greatly increased, resulting in adhesions and movement restrictions.

All in all, with adequate therapy, there is an inconsequential healing, so that a bursitis of the hip is classified as rather harmless.

diagnosis

If a patient suffers from exercise-related hip pain, a specialist should be consulted urgently.
The diagnosis of bursitis on the hip usually takes place in several steps. At the beginning of an extensive doctor-patient interview (anamnesis) must be performed. During this conversation, the affected patient should be described in detail the perceived symptoms.

In addition, a comprehensive physical examination should be carried out in which both the painful hip joint, as well as the lymph node status must be collected.
In addition to the examination of the affected hip joint and the healthy joint must be assessed. Only in this way can a comparative assessment of the two hips be made.
If there is a suspicion of bursitis on the hip, both sides are first examined for heat differences. In addition, pressure pain can be elicited when palpating the inflamed joint.

Following the physical examination, in which the range of motion of the affected hip is also assessed, a blood sample is usually taken followed by a laboratory examination of the blood samples. In the case of bursitis of the hip certain parameters are clearly increased (eg C-reactive protein, leukocytes).
Nevertheless, bursitis may also be present if the inflammatory parameters in the blood sample show perfectly normal values.
In such cases, it is a congestion-induced bursitis. Afterwards, an additional ultrasound of the affected hip can be performed. In this imaging procedure, the bursa in the hip can be made visible, inflammatory processes can be detected and their possible cause can be unmasked.

Rarely, an MRI of the hip can be useful. The MRI is particularly good at the soft tissue, ie the bursa of the hip. As a side effect, the hip joint can also be assessed for inflammation and cartilage damage by means of the MRI of the hip.

therapy

Hip bursitis in most cases heals completely within a few weeks without any medical intervention.
The affected patients can perform pain relief during the healing phase. Especially by applying cooling ointments or gels can treat the pain of bursitis of the hip well.
In addition, the careful cooling of the hip can be done with the help of cooling pads. However, these should never be placed directly on the surface of the skin (risk of frostbite).
Since this disease is an inflammation, warming measures should be avoided at all costs. These would boost the inflammatory processes and aggravate the symptoms.
In order to positively influence the healing process, the affected hip joint can be immobilized by a bandage or a splint. However, the full protection of the affected hip should only take place over a short period of time. The reason for this is the danger that immobilizing the hip joint for too long a period can lead to persistent restrictions of movement. For this reason, if bursitis of the hip is present, it is recommended that the affected joint be moved slowly and without much effort after a short rest period. In this context, especially the regular physiotherapy can help to positively influence the healing process of the bursitis.
Causes the bursitis in the hip very severe pain, painkillers (analgesics) can be taken. In particular, medicines that have the active ingredient Ibuprofen are particularly suitable for the treatment of bursitis of the hip. The reason for this is the fact that the active ingredient Ibuprofen can also have an anti-inflammatory effect in addition to its analgesic properties.

Taping on a bursitis of the hip

With bursitis of the hip, it is possible to tap the hip joint with Kinesio tapes. Instructions can be found on various pages of different providers of tapes. The goal is to stabilize the hip joint and distribute the forces acting evenly on the muscular and tendon apparatus. So the joint should be relieved and the healing of a bursitis should be supported.

However, taping is not an independent therapy, but should be considered as a supportive measure of conservative therapy.

The tape is attached to the lateral thigh without pulling. It is a Y tape. The tape is stretched slightly before it is attached. One end is placed over the greater trochanter, which is best felt with a guide. Then you angle the leg in a relaxed position and stick the second part of the Y-shaped end in the direction of the coccyx without pulling. Now stretch out the leg loosely and stick the long end of the Y-tape also without pulling firmly on the outer side of the thigh.

surgery

In advanced bursitis, surgery is usually the only way to stop the inflammation and to avoid chronic hip pain. Also a bacterial joint infection is a reason for an operative treatment, because here the vitality of the joint can be threatened. In a bursitis, which does not heal or recurrent despite all conservative measures, the inflamed bursa is removed in a surgical procedure. This procedure is called a bursectomy. In the case of a bacterial infection, an antibiotic is additionally administered against the germ. Bacterial infections, however, are less common cause of bursitis of the hip and usually occur in patients with a certain risk profile, for example, after surgery or in a poor immune situation on.

forecast

In most cases, a bursitis of the hip heals completely by sparing the joint and drug therapy after a few days or weeks. Especially when overloading of the joint was the cause of the inflammation, a good healing process can be assumed.

If the inflammation and thus the symptoms occur after surgery or if there is a suspicion of a bacterial cause, the prognosis is a little worse. In these cases, chronic inflammation may develop and only surgery can lead to a cure. In these cases, complications such as nerve damage, infection, or restricted mobility of the affected joint are much more common.

Duration of a bursitis of the hip

Bursitis on the hip can be both acute and chronic. An acute inflammation usually manifests itself after a slight injury or an overload of the joint. With protection and an anti-inflammatory medication with ibuprofen or diclofenac, such an inflammation usually ceases within a week.

With a longer duration or very strong pain, which does not improve under protection and pain medication, a doctor should be consulted. Chronic events may show symptom-free intervals or cause pain throughout. Here courses of several weeks to months are possible. Then surgery is usually necessary if all conservative measures do not help.

frequency

How often a trochanteric bursitis occurs can not be precisely stated on the basis of insufficient data. It can be assumed that the inflammation of the bursa occurs relatively frequently, whereby only a part of the persons concerned visit a doctor.
Most commonly, trochanteric bursitis affects individuals with inflammation due to overstressing the affected joint. Risk groups are, for example, competitive athletes, but also occupational groups with increased physical strain. People who suffer from rheumatoid joint disease may also be more likely to be affected by a trochanteric bursitis.

Sports and bursitis of the hip

An inflammation of the bursa of the hip can be caused by over- or under-loading during sport. On the other hand, regular and sufficient exercise is important to strengthen the musculature and the joint apparatus, which in turn can prevent bursitis and joint wear.

Often, runners are affected by bursitis on the hip, as they exert high forces and pressure on the hip joint. With a permanent overload, lack of rest periods and lack of stretching, it can therefore quickly lead to bursitis. This can be prevented by maintaining adequate rest periods and strengthening the muscles and the joint apparatus in training.

After a hip bursitis, slight stretching exercises can help to heal. However, an extensive sports program should be avoided in the phase of inflammation. The joint must then be spared. Recommended are joint-friendly sports such as swimming, cycling and Nordic walking. Also, Pilates and water aerobics are very well suited to keep your joints fit.

prophylaxis

A major reason for the occurrence of bursitis of the hip is the excessive mechanical stress of the respective joint. For this reason, when bursitis occurs, there should be an accurate self-analysis of the individual load on the joint.
For example, if a new sport was started shortly before the inflammation, or some other physical activity may be the cause of the inflammation, these activities should be avoided or the burden reduced. A physical examination with a specialist in orthopedics may also be useful, as this can perform a measurement of the legs in order to rule out different lengths of legs as a possible cause, if necessary. There, a running analysis can also give an indication of why the bursa inflammation has occurred. An orthopedic examination is particularly useful in children, since at a young age disorders of the musculoskeletal system can often show in a trochanteric bursitis.

For example, if a leg length difference is detected during a physical exam, an insert can help eliminate the problem and eliminate the cause of bursitis. It is important that at the first signs of inflammation of the bursa takes place a protection of the affected joint.

A drug prevention that prevents the occurrence of a trochanteric bursitis does not exist. Although medicines can alleviate the symptoms and fight an existing inflammation, they are useless as a prophylaxis against further inflammation because they do not treat the cause of the problem but only the symptoms of the disease.

Stretching exercises for the prophylaxis of bursitis of the hip

To prevent bursitis in the hip, stretching exercises are highly recommended. Even after an healed bursitis of the hip, stretching exercises can help to stabilize the hip joint and thus prevent misuse or overloading of the bursa (bursa synovialis). Gentle stretching exercises may also be complementary to the physical therapy of mild bursitis.

In the phase of inflammation, however, they should only be performed under the guidance of a physician or physiotherapist. Especially for runners, it is recommended to do some stretching exercises before training as a prophylaxis.

Here are some example exercises:

  1. Exercise: Elasticity of the hip flexors: Stand upright in a firm position. Now pull a heel to the buttocks and hold it there with the equilateral hand. Watch for a firm stomach and push the pelvis forward until you feel a stretch. They hold this position for 30 seconds. Now change the leg. Make sure that your heel does not touch the buttocks.
  2. Exercise: Stretching the hip flexors and thighs front: Set a wide step position. Support with both palms on the front leg and keep the trunk upright. Do not make a hollow cross. Be careful not to rotate the pelvis. Now push the pelvis forward until you feel a stretching sensation and hold the position for at least 30 seconds. Now change the page.
  3. Exercise: Stretching the gluteal muscles: Lie in the supine position. Angle your right leg. With the right hand, they cover the right knee. With the left hand they grip the right lower leg. Now pull the leg in the direction of the left shoulder, so that they feel a stretch. Be careful not to feel strain on the knee. Hold the position for 30 seconds. Now change the page.

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