Hip bursitis

Background

Hip anatomy.

Extracapsular ligaments (anterior right hip).

Extracapsular ligaments (posterior right hip).

Clinical Features

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

Bursa	Location	Risk Group	Symptoms
Trochanteric	Between gluteus maximus and posterolateral greater trochanter	Most common in female runners and elderly women (rheumatoid arthritis)	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			Pain with extension of hip Tenderness over middle third of inguinal ligament in area of femoral pulse
Ischial		Occurs most often in sedentary patients who sit on a hard surface for long periods of time	Pain is present over the ischial prominence Pain is increased in the sitting position
Iliopectineal	Between the hip joint and iliopsoas muscle

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