Bursitis of the hip

Synonyms

Bursitis

General

The term "bursitis" refers to a disease in which inflammatory processes occur 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. They are typically located between two fixed joint parts that can be moved relative to one another.
In the case of the hip, the bursa lies between the head of the thigh bone (lat. Femur) and the socket of the hip bone.

Read more on the topic: Bursitis

The function of a bursa is to evenly distribute the pressure exerted by the individual joint structures and to make it easier for cartilage and bone to slide onto one another. A bursa is with one membrane lined and covered by a resistant capsule surround. The capsule of a bursa 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 on. On the other hand, the development of bursitis on the hip is comparatively rare.

Affected patients notice pain in the hip joint and groin area at an early stage if they have bursitis on the hip. The pain caused by the inflammatory processes can be felt localized in the hip region or radiated into the lower back and thighs. In addition, the symptoms of bursitis on the hip typically increase significantly under stress.

Definition / introduction

The clinical picture of a bursitis of the hip is an inflammation of the above large rolling mound lying so-called Bursa. This is an anatomical structure that extends over the portion of the Thighbone lies.
There are many places in the body that these bursa can be found. A bursa is a sack filled with a liquid that is close to Joints occurs where there is the most pressure load. At these points, the bursa ensures that the mechanical pressure and friction caused by other structures, which naturally occur there through movement, are not transferred directly to the musculoskeletal system, but are somewhat reduced by the bursa.
Due to the increased mechanical stress in these areas, however, it also occurs more frequently Bursitis. If such inflammation affects the bursa above the femur in the area of ​​the roll mound, it is medically called Trochanteric bursitis designated.
A special feature of the bursa on the hip is that they are in close proximity Insertions of heavily used muscles can be found. The hip muscles, which are heavily stressed in some sports, can irritate the bursa and develop the clinical picture of bursitis.

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The hip joint is one of the joints that are exposed to the greatest stress.
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causes

The partially permeable capsule of the bursa ensures, above all, the supply of nutrients that can diffuse from the bloodstream into the bursa. However, the less sealed parts of the bursa capsule can also Pathogens penetrate and promote the development of inflammatory processes in the bursa.
As a rule, the pathogens that cause bursitis on the hip come from a focus of infection that is elsewhere on the body. In patients who are under a restricted immune system suffer or do not have infections treated promptly and in a targeted manner, these pathogens can spread further.
Viral and bacterial pathogens in particular can easily get into the blood circulation and settle in another part of the body. In this way, the causative pathogens are also transported to the hip area and can penetrate the bursa through the smallest tissue defects. These pathogens can settle and multiply within the bursa and initiate inflammatory processes. As a result, a Bursitis on the hip.

As a rule, the presence of such a bursitis on the hip is first noticed by the affected patient. Due to the deep position of the bursa on the hip, the typical signs of inflammation (such as redness and swelling) can hardly be observed on the surface of the body. Another cause of bursitis is persistent Pressure overload in the affected joint. The direct cause in this context are persistent and / or recurring movements. Because of this, especially athlete (e.g. cross-country skiers) affected by inflammatory processes in the area of ​​the bursa.

In addition, external injuries can be the cause of bursitis of the hip. In this context, a distinction is made between two different forms:

• direct violence (e.g. a blow to the hip) can cause the bursa to fill with blood and inflame
• through an open injury in the hip area, bacterial pathogens can penetrate the joint and lead to bursitis on the hip.

Jogging and bursitis of the hip

A particularly high risk, Compared to the rest of the population, joggers and amateur runners develop bursitis of the hip. These often give their hip joints a conscience Overloading or improper loading which can lead to bursitis. The bursa serves as a kind of buffer, which is supposed to distribute the pressure acting on the joint and the friction prevailing there evenly on the tendons, bones, muscles and skin. The aim is to protect the joint apparatus and enable smooth movements. Bursitis is usually caused by minor injuries or excessive pressure on the bursa. Furthermore, with runners it is often the Achilles tendon bursa endangered for a bursitis, as high forces act on the foot when it rolls and pushes it off.

Read more on the subject at: Hip pain while or after jogging - what do I have?

Symptoms

Patients who suffer from bursitis typically have few symptoms at the beginning of the disease.
Occasionally the affected patients report a burning or slightly rubbing sensation. If the hip affected by the bursitis continues to be stressed, the symptoms usually increase rapidly in intensity.

Typical symptoms of hip bursitis are Strength Pain which are mainly provoked by pressure loads.
In addition, in the area of ​​the affected hip, especially with pronounced disease processes, there is a clear one warming noticeable on the skin surface.
Visible Redness In the case of bursitis of the hip, they appear very late in most cases. The reason for this is the fact that the structures of the Hip joint lie very deep and are covered by strong muscle layers and subcutaneous fat.
In addition, are also Swelling in the presence of a bursitis of the hip noticeable quite late. However, if there is fluid retention in the area of ​​the affected hip, significant swellings usually develop.
Since there is an increase in volume of the bursa due to the inflammatory processes, the normal one also becomes Range of motion of the hip joint clearly restricted. Above all, the ability of the inflamed hip to stretch and rotate is inhibited at an early stage in most patients. In some cases, the bursitis in the hip even spreads to the surrounding tissue. This can lead to significant reddening of the adjacent extremities.
In addition, pronounced general symptoms can be caused if the disease progresses particularly well. The affected patients often develop increasing fatigue, Exhaustion and fever. Since hip bursitis is often a bacterial infection, it can also cause regional swelling Lymph nodes come.

Is that dangerous?

Most bursitis is sterile, which means that it was not triggered by the invasion of pathogens such as bacteria or viruses, but rather is based on incorrect or overstressing of the joint. These are harmless and heal completely within a few weeks with protection of the joint and symptom-oriented therapy. Painkillers and cooling of the joint are recommended.

Trochanteric bursitis can also be triggered by pathogenic germs that have either been washed in via the bloodstream from another part of the body or have penetrated the joint from outside through an open injury. Since the capsule of the bursa is not particularly tight, it is not difficult for the pathogen to overcome it and trigger an inflammation. In this case, in addition to the relief and cooling of the joint, a pathogen-adapted drug therapy for elimination is necessary in order to induce healing. If this form of inflammation is not discovered or treated appropriately, the risk of chronification is greatly increased, which results in adhesions and restricted mobility.

All in all, adequate therapy leads to healing without consequences, so that a bursitis of the hip is classified as rather harmless.

You can find additional information at: How long could my bursitis last?

diagnosis

If a patient suffers from stress-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, an extensive doctor-patient discussion (anamnesis) must be carried out. During this conversation, the affected patient should be described the perceived complaints in as much detail as possible.

In addition, an extensive physical examination should be carried out in which both the painful hip joint and the lymph node status must be recorded.
In addition to examining the impaired hip joint, the healthy joint must also be examined. This is the only way to make a comparative assessment of the two hips.
If there is suspicion of bursitis on the hip, both sides are first examined for differences in temperature. In addition, palpation of the inflamed joint can trigger pressure pain.

Following the physical examination, which also assesses the range of motion of the affected hip, a blood sample is usually taken, followed by a laboratory test of the blood samples. In the case of bursitis of the hip, certain parameters are significantly increased (e.g. C-reactive protein, leukocytes).
However, bursitis can also be present if the inflammation parameters in the blood sample show perfectly normal values.
In such cases it is an overload-induced bursitis. An ultrasound of the affected hip can then be performed. With this imaging procedure, the bursa in the hip can be made visible, inflammatory processes detected and their possible cause unmasked.

An MRI of the hip can rarely be useful. The MRI shows the soft tissues particularly well, ie the bursa of the hip. As a side effect, the hip MRI can also be used to assess the inflammation and cartilage damage.

therapy

Bursitis in the hip area heals completely in most cases within a few weeks without medical intervention.
Affected patients can take pain-relieving measures during the healing phase. Mainly by applying cooling ointments or Gels treat the pain of hip bursitis well.
In addition, careful cooling of the hips can be achieved with the help of Cooling pads respectively. However, these should never be placed directly on the skin surface (risk of frostbite).
Since this is an inflammation, should warming measures absolutely avoided become. These would stimulate the inflammatory processes and worsen the symptoms.
In order to positively influence the healing process, the affected hip joint can be treated with a Association or one rail be immobilized. However, the affected hip should only be completely protected for a short period of time. The reason for this is the risk that immobilizing the hip joint for too long can lead to persistent movement restrictions. For this reason, if there is a bursitis on the hip, it is recommended to move the affected joint slowly and without great stress after a short rest phase. In this context, the regular implementation of a physical therapy help to positively influence the healing process of bursitis.
If the bursitis causes severe pain in the hip, pain killers can be used (Analgesics) be taken. Mainly drugs that have the active ingredient Ibuprofen are particularly suitable for treating hip bursitis. The reason for this is the fact that the active ingredient ibuprofen, in addition to its pain relieving properties, can also have anti-inflammatory effects.

Taping for bursitis of the hip

In the case of bursitis of the hip, it is possible to use the hip joint Kinesio tapes to tape. Instructions for this can be found on various pages from various providers of the tapes. The goal is to get the hip joint too stabilize and to distribute the acting forces evenly to the muscles and tendons. That's how it should be Joint are relieved and the healing of a bursitis supported become.

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

The tape will without a train attached to the lateral thigh. It's about a Y-tape. The tape is stretched slightly before it is applied. One end is placed over the greater trochanter, which is best palpated with instructions. Then you bend the leg in a relaxed position on the side and glue the second part of the Y-shaped end in the direction of the coccyx without tension. Now stretch out the leg loosely and glue the long end of the Y-tape to the outer side of the thigh, also without pulling.

surgery

At a advanced bursitis is usually an operation of the only wayto stop inflammation and avoid chronic hip pain. Also one bacterial joint infection is a reason for surgical treatment, as this can threaten the vitality of the joint. In the case of bursitis, despite all conservative measures does not heal or keep returning, is undergoing a surgical procedure the inflamed bursa is removed. This intervention is known as Bursectomy. In the case of a bacterial infection, a antibiotic administered against the germ. However, bacterial infections are less likely to cause hip bursitis and usually occur in patients with a certain risk profile, for example after surgery or if the immune system is poor.

forecast

In most cases, hip bursitis heals by protecting the joint and drug therapy after a few Days or weeks completely off. A good healing process can be assumed, especially if overstressing the joint was the cause of the inflammation.

If the inflammation and with it the discomfort occur after an operation or if a bacterial cause is suspected, the prognosis is slightly worse. In these cases it is possible that a chronic inflammation developed and only an operation can lead to a cure. In these cases, complications are like Nerve damage, infections, or restricted mobility of the affected joint far more often.

Duration of bursitis of the hip

Bursitis of the hip can both an acute and a chronic course demonstrate. Acute inflammation usually shows up after a minor injury or overuse of the joint. With care and an anti-inflammatory medication with Ibuprofen or Diclofenac Such an inflammation usually subsides within a week.

At a longer duration or very severe painwho do not improve even with rest and pain medication, a doctor should be consulted. Chronic courses can symptom-free intervals demonstrate or pain throughout cause. Here are runs of several weeks to months possible. Then an operation is usually necessary if all conservative measures do not help.

frequency

How often trochanteric bursitis occurs cannot be precisely determined based on a lack of data. It can be assumed that the inflammation of the bursa relatively often occurs, with only a fraction of the affected people seeing a doctor.
Trochanteric bursitis most commonly affects people who have the inflammation due to overuse of the affected joint. Risk groups are for example Competitive athlete, but also Occupational groups with increased physical stress. Even people who participate in a rheumatoid joint disease suffer from trochanteric bursitis more often.

Exercise and bursitis of the hip

A Bursitis the hip can through excessive or improper exercise during sport occurrence. On the other hand, regular and sufficient exercise is important in order to strengthen the muscles and the joint apparatus, which in turn improves thecan prevent bruises and joint wear.

Are common runner affected by bursitis on the hip, there high forces and much pressure exerted on the hip joint. At a permanent overload, lack of rest periods and lack of stretch, it can therefore quickly lead to bursitis. This can be prevented by taking sufficient rest periods and strengthening the muscles and the joints during training.

After a previous bursitis in the hip, can light stretching exercises help support healing. However, an extensive exercise program should be avoided in the inflammation phase. The joint must then be spared. Are recommended joint-friendly sports like swimming, cycling and Nordic walking. Pilates and aqua aerobics are also very suitable for keeping fit while being gentle on the joints.

prophylaxis

One of the main causes of hip bursitis is that excessive mechanical load of the respective joint. For this reason, if a bursitis has occurred, a exact self-analysis take place with regard to the individual load on the joint.
For example, if a new sport was started shortly before the inflammation or another physical activity could be the cause of the inflammation, these activities should be avoided or the stress should be reduced. A physical exam on one Specialist in Orthopaedics can also be useful because this one Measurement of the legs can perform to legs of different lengths to be able to exclude possibly as a possible cause. There can also be a Running analysis provide an indication of why the bursa became infected. Especially with children An orthopedic examination makes sense, as disorders of the musculoskeletal system can often show up in trochanteric bursitis at a young age.

For example, if a physical examination reveals a difference in leg length, a inlay the problem and the cause of the development of bursitis are eliminated. It is important that at the first signs of an inflammation of the bursa, a Protection of the affected joint takes place.

There is no drug prevention that prevents the occurrence of trochanteric bursitis. Medicines can alleviate the symptoms and fight an existing inflammation, but they are useless as a prophylaxis against further inflammation, since they do not treat the cause of the problem, only the symptoms of the disease.

Stretching exercises for the prophylaxis of bursitis of the hip

To prevent bursitis in the hip, are Stretching exercises are highly recommended. Even after the hip bursitis has healed, stretching exercises can help to close the hip joint stabilize and thus prevent incorrect or overstressing of the bursa (bursa synovialis). Gentle stretches can also be one Supplement to physical therapy represent a slight bursitis.

However, in the inflammation phase, they should only be carried out under the guidance of a doctor or physiotherapist. Especially for runners It is recommended to do some stretching exercises before training as a prophylaxis.

Below are a few Sample exercises listed:

1. Exercise: Stretching the hip flexors: Stand upright in a firm stance. Now pull one heel to your buttocks and hold it there with your hand on the same side. Make sure you have a firm stomach and push your pelvis forward until you feel a stretch. Hold this position for 30 seconds. Now change your leg. Make sure that your heel does not touch your buttocks.
2. Exercise: Stretching the hip flexors and front thighs: Imagine a wide stride position. Support yourself with both palms on your front leg and keep your torso upright. Don't make a hollow back. Be careful not to rotate the pelvis. Now push the pelvis forward until you feel a stretch and hold the position for at least 30 seconds. Now change sides.
3. Exercise: stretching the glutes: Lie on your back. Bend your right leg. Hold your right knee with your right hand. With your left hand you grip your right lower leg. Now pull your leg towards your left shoulder so that you feel a stretch. Make sure you don't feel any strain on your knee. Hold the position for 30 seconds. Now change sides.