Hip bursitis

Hip anatomy.

Trochanteric Bursitis

Background

• Trochanteric bursa lies between gluteus maximus and posterolateral greater trochanter
• Most common in female runners and elderly women (rheumatoid arthritis)

Clinical Features

• Pain when lying on affected side
• Pain worsened by walking and climbing stairs
• Pain over greater trochanter (posterolateral hip pain)
• Pain to resisted abduction or adduction of hip

Iliopsoas Bursitis

Clinical Features

• Pain with extension of hip
• Tenderness over middle third of inguinal ligament in area of femoral pulse

Ischial Bursitis

Background

• Occurs most often in sedentary patients who sit on a hard surface for long periods of time

Clinical Features

• Pain is present over the ischial prominence
• Pain is increased in the sitting position

Iliopectineal Bursitis

Background

• Bursa is interposed between the hip joint and iliopsoas muscle

Clinical Features

• Pain sensed over the anterior pelvis and groin on the affected side
• Increased pain with hip extension

Differential Diagnosis

Hip pain

Acute Trauma

• Femur fracture
  • Proximal
    • Intracapsular
      • Femoral head fracture
      • Femoral neck fracture
    • Extracapsular
      • Intertrochanteric femur fracture
      • Trochanteric femur fracture
  • Shaft
    • Mid-shaft femur fracture (all subtrochanteric)
• Hip dislocation
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture

Chronic/Atraumatic

• Hip bursitis
• Psoas abscess
• Piriformis syndrome
• Meralgia paresthetica
• Septic arthritis
  • Septic arthritis of the hip (peds)
• Obturator nerve entrapment
• Avascular necrosis of hip

Management

• NSAIDs, rest, heat

Disposition

• Admit for IV antibiotics if infected bursa is suspected

See Also

• Bursitis
• Hip pain