PCI Physical Medicine & Rehabilitation specialists can diagnose and treat all types of back and joint pain, including hip bursitis.
Greater Trochanter Pain Syndrome, or hip bursitis, is a common lateral hip pain. Historically, hip bursitis was thought to be due to an inflamed bursa. However, evidence demonstrates lateral hip pain is mostly due to tendinosis.
Tendinosis is the accumulation of chronic degenerative micro-tears in a tendon. Tendons are the part of a muscle that attaches to bone. The hip has a common attachment point, also called the greater trochanter, for many of the muscles that control hip movement. This is located on the lateral hip at the site of pain.
Lateral hip pain is better referred to as greater trochanteric pain syndrome. It is usually a secondary disorder caused by hip girdle muscle inhibition from low back and hip joint pain. When it is a primary disorder, it is usually caused by blunt trauma to the lateral hip.
Symptoms of greater trochanteric pain syndrome are lateral hip pain that may radiate into the buttock or down the side of the leg. Pain usually does not radiate past the knee.
People who develop lateral hip pain usually have long-standing back pain, hip pain, or a bio-mechanical deficiency of the leg. These issues lead to muscle imbalances in the hip girdle through what is known as neuromuscular inhibition. This causes muscles that have the same common nerve roots as the areas of pain in the back or the hip joint to receive referred pain and often function inefficiently. At first these imbalances may not cause pain. Over time, as the tendons are stressed, they develop tendinosis and pain starts to become noticeable.
Initial treatment of lateral hip pain consists of therapeutic exercise targeted to re-balance the muscular deficiency in the hip girdle and core muscles, along with acetaminophen, ice, intermittent rest, activity modification, and occasionally, a cortisone injection. If a cortisone injection is performed, it should be done by ultrasound guidance to avoid injection directly into any tendon. Injection of cortisone into a tendon has been shown to be detrimental to healing and can cause further degeneration.
In addition to direct treatment of the lateral hip pain, treatment of low back or hip joint pain should be performed. If the back or hip pain is driving the muscle imbalance and greater trochanteric pain syndrome, then direct treatments for lateral hip will not be effective long term.
If pain does not respond to conservative measures (i.e. therapeutic exercise, medication, cortisone injection) along with successful treatment of primary contributing factors (low back or hip pain) then regenerative medicine should be considered.
If the degenerative tear is too large to be treated adequately with regenerative medicine or is refractory to all non-surgical treatments, then surgical referral would be appropriate.