Hip bursitis.

Bursitis of the hip joint is an inflammatory process that develops in the synovial periarticular bag, which acts as a kind of “shock absorber” and, when muscles slide, helps reduce friction between the bones and the soft tissues covering them.

In medicine, bursitis refers to a group of orthopedic diseases, the development of which is characterized by inflammation in the synovial joint bags, leading to the accumulation of the resulting exudate in the joint cavities - i.e. inflammatory fluid.

The periarticular synovial bursa is a small cavity located around the hip joint and filled with fluid. Various injuries, as well as excessive physical overload of tendons and muscles, can cause bursitis (Latin bursa - "bag") as an inflammatory process that can cover the trochanteric bursa, sciatic bursa or iliopectineal bursa in the hip joint. Among the unfavorable factors that contribute to the development of the inflammatory process, one can note a sedentary lifestyle, hypothermia, obesity and congenital anomalies, in particular, the difference in leg length. Most often, this disease occurs in middle-aged and elderly women.

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Causes of hip bursitis

Bursitis of the hip joint is an inflammatory process that affects the synovial bursa of the hip joint (acetabular or sciatic).

The causes of hip bursitis are in most cases associated with various injuries and damage to the femur. The main factors that provoke this disease include:

• Excessive regular stress on the hip joint.
• Diseases of the spine (scoliosis, arthrosis and arthritis).
• Uneven leg lengths.
• Surgical interventions on the hip joint.
• Rheumatoid arthritis.
• Osteophytes (so-called "bone spurs").
• Salt deposition.

Intensive running and cycling, frequent climbing stairs, and standing for a long time lead to excessive loads on the hip joint, and subsequently to the development of an inflammatory process in the synovial bags. With different leg lengths, irritation of the synovial bags also often occurs, leading to the development of bursitis. Various surgeries, in particular, hip replacement, can cause this disease. Damage to the femur due to strong blows and falls, as well as osteophytes that occur in the area of the tendons, attaching to the trochanter of the femur, often become the causes of bursitis.

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Symptoms of hip bursitis

The main symptom of hip bursitis is acute pain in the hip joint, which is localized on the outer side of the thigh. At the beginning of the disease, the pain is strong and intense, but as the pathological inflammation spreads, it dulls over time.

Other symptoms of hip bursitis include:

• A painful swelling at the site of the damaged joint, which is round in shape and reaches up to 10 cm in diameter.
• Swelling of the tissues around the synovial bursa.
• Elevated temperature (sometimes up to 40°).
• Hyperemia of the skin.
• General malaise.
• Violation of the proper functioning of the joint.

Trochanteric bursitis causes severe pain in the outer thigh, making it difficult to lie on the affected side. The patient experiences heavy sleep. Burning pain interferes with climbing stairs and restricts movement. Sciatic bursitis causes a dull ache in the upper thigh bone, especially when climbing up and bending and straightening the hip. The pain may increase with prolonged sitting on a hard surface.

When bursitis becomes chronic, the symptoms become less pronounced, and a small swelling of a rounded shape and soft consistency is observed in the area of the inflamed synovial bursa. Chronic bursitis is characterized by the absence of burning pain and preservation of joint functions. Exacerbation of the disease causes an increase in the amount of exudate in the cavity of the damaged bursa, which often leads to the formation of a cystic cavity filled with fluid.

If the inflammation of the synovial bag of the hip joint is caused by an infectious agent, purulent bursitis may develop. Its main symptom is sharp pain, which is observed when abducting the limb, as well as flexing and extending the hip. Swelling is localized on the outer part of the thigh. Due to severe pain, a person cannot fully bend or straighten the hip, ‒ thus, the hip is constantly in a semi-bent position and abducted outward.

Trochanteric bursitis of the hip joint

Bursitis of the hip joint occurs due to inflammation of one of the three periarticular bursae: iliopectineal, sciatic or trochanteric.

Trochanteric bursitis of the hip joint is caused by an inflammatory process in the trochanteric bursa, which is located near the greater trochanter of the femur, and is much more common than the other two types of bursitis. This disease is characterized by symptoms such as pain in the area of the greater trochanter (i.e., the bony elevation located on the lateral surface of the femur), as well as swelling in the area of inflammation, discomfort during movement, general malaise, and fever. This disease often develops in people who are actively involved in sports, mainly in women, since the female pelvis is much wider than the male one, so the greater trochanter in women is located further from the midline of the body, and this provokes more intense friction of the muscles against it.

The pain that occurs as a result of the development of trochanteric bursitis is sharp, burning, spreading along the outer surface of the thigh. Unpleasant pain sensations decrease in a state of complete rest, but with the slightest loads (climbing stairs, hip rotations, squats) they sharply increase. The patient often complains of night pains that occur when lying on the sore side. In athletes involved in professional running, with an increase in sports load, an increase in pain is observed ‒ most often this is associated with an increase in distance or difficulty of training.

Bursitis can be chronic over a long period of time. Acute trochanteric bursitis most often occurs with trauma – a fall or a sharp collision with some object. In this case, the blow is accompanied by a characteristic click. Trochanteric bursitis is diagnosed using the Ober test (a method of abducting the leg), palpation, and in some cases, a special X-ray examination to detect calcifications (ossified areas). Magnetic resonance therapy can be used to identify areas of exudate accumulation and inflammation.

Diagnosis of hip bursitis

Bursitis of the hip joint requires an accurate diagnosis through a complete objective examination by a qualified medical specialist. During the examination, the doctor asks the patient about the nature of the pain, the reasons for its occurrence, localization, etc. Palpation of the hip joint is performed, as well as the Ober test with hip abduction.

Diagnosis of hip bursitis is characterized by some difficulties due to the deep location of the hip joint and its coverage by muscles. Thus, external examination of the joint is impossible, and there are also difficulties with taking a puncture or performing arthroscopy. Therefore, the diagnosis of this disease is based on two main factors: analysis of pain syndrome and a special X-ray examination. When detecting pathology, increased pain and sensitivity in places of protruding sections of the femur are taken into account. To exclude injuries and other pathologies associated with the hip joint, such as arthritis, MRI and bone scanning are performed. The diagnosis is confirmed by administering a local anesthetic to the patient, after which relief is observed.

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Treatment of hip bursitis

Bursitis of the hip joint, first of all, requires conservative treatment, which consists of modifying physical activity, i.e. limiting any activity that increases pain. The doctor prescribes non-steroidal anti-inflammatory drugs to the patient, with the help of which it is possible to relieve pain and stop the development of the inflammatory process. In order to relieve pain in bursitis, effective hormonal drugs are used in their competent combination with local anesthetics.

Treatment of hip bursitis in non-advanced cases is carried out on an outpatient basis and includes a single injection of drugs directly into the damaged synovial bursa. If bursitis flares up again and pain syndrome returns, the patient may need another injection.

Conservative treatment includes therapeutic exercise. The selection of an effective set of exercises will depend on the course of the disease, but first the patient is prescribed anti-inflammatory drugs and only after that – preventive manipulations (electrophoresis and ultrasound, therapeutic gymnastics).

In the treatment of hip bursitis, it is very important not only to relieve inflammation, but also to prevent chronic development of the disease. For this purpose, along with drug therapy, compresses with plantain, sage, as well as calendula and pine buds are used - medicinal plants that have pronounced anti-inflammatory and anti-edematous properties. Other effective means for reducing the recurrence of hip bursitis include:

• Osteo-Vit. A modern biologically active complex, an effective natural chondroprotector, ensuring the efficiency of recovery processes, as well as the normalization of venous blood supply to the articular and cartilaginous tissue. The preparation contains vitamins D and B6, which help normalize mineral metabolism in the human body. The preparation contains drone brood homogenate, which is a natural source of amino acids.
• Dihydroquercetin plus. An antioxidant whose action is aimed at nourishing joint tissue and quickly restoring blood microcirculation. With the help of this product, joint tissue cells are freed from free radicals that hinder the regeneration process.
• Elton P, Leveton P. Effective biologically active complexes, including bee products, as well as various medicinal herbs, the action of which is aimed at increasing performance, endurance, providing the body with essential microelements, vitamins for strengthening bones, enzymes and useful amino acids. It is especially important to take these drugs during the rehabilitation period, since with the help of these biologically active complexes it is possible to restore normal blood microcirculation in damaged tissues and vessels. The drugs have pronounced anti-inflammatory, anti-edematous and wound-healing properties. This is of particular importance if the underlying cause of hip bursitis was an injury.

Surgical treatment is used by doctors only in rare cases when conservative treatment does not give the desired results, and pain and inflammation persist. In such a situation, the only solution is to remove the damaged synovial bursa, which does not affect the normal functioning of the hip joint in any way. In modern medicine, the so-called "arthroscopic" removal of the damaged synovial bursa is actively used. This operation is performed by making a small incision in the hip area and internally inserting an arthroscope - a device that allows the doctor to freely manipulate surgical instruments in order to remove the synovial bursa. This surgical intervention is characterized by a minimal level of trauma for the patient, as well as a less painful recovery period.

Treatment of bursitis of the hip joint with folk medicine is, first of all, effective in terms of reducing the inflammatory process. It is possible to recommend the use of such a resorption compress: it is necessary to grate 1 tbsp. of laundry soap, add 1 tbsp. of honey, the same amount of grated onion and mix everything. On a piece of polyethylene it is necessary to lay a clean cotton cloth and lay out the prepared therapeutic mass. Apply the compress to the inflamed area and wrap it with woolen cloth. It is advisable to use the compress for 7 days. Before starting treatment it is recommended to consult with the attending physician.

Prevention of hip bursitis

Hip bursitis can be prevented by taking preventive measures in advance.

Prevention of hip bursitis primarily comes down to eliminating any load on the joint, as well as limiting physical activity that can provoke inflammation of the synovial bursa. It is necessary to maintain muscle tone, control weight, and use special devices if the legs are of different lengths.

Of course, it is impossible to insure against impacts and injuries of the musculoskeletal system, but the risk of developing bursitis can be reduced by minimizing the load on the pelvic bones. To do this, you should avoid lifting various weights and excess weight. If there is excessive load on the legs (for example, when working while standing), it is necessary to give the body adequate rest. An active lifestyle, as well as moderate physical activity and giving up bad habits will help improve health and prevent the development of bursitis.

To train the hip joints, it is recommended to perform exercises aimed at strengthening the abductor muscles of the hip, which are the stabilizing muscles of this joint:

• Take a position for table push-ups, keeping your back straight without bending in the lumbar region. The body should take the position of a straight line. In this position, smoothly move your right leg to the side and return back. Do the same with your left leg. Exercise frequency: 5-10 times for each leg.
• Take the starting position standing, put your legs together, then bend your left leg at the knee, move your pelvis towards your right leg and smoothly bend your body forward, keeping your back straight. Repeat the exercise with the other leg.

Regular exercise, a healthy lifestyle, and a diet rich in minerals (especially fluorine and calcium) will help prevent the occurrence of any hip joint pathologies.

Hip Bursitis Prognosis

Bursitis of the hip joint is treated quite successfully, especially if the disease is detected in time. Naturally, diagnosis and treatment of bursitis requires the qualifications and experience of a medical specialist. Self-treatment with analgesics and folk remedies (compresses, ointments, etc.) alone will not give positive results, so if symptoms of bursitis are detected, you should consult a doctor as soon as possible.

The prognosis for hip bursitis is always favorable with effective treatment. In most cases, this disease responds well to conservative treatment methods used in modern medicine. Anti-inflammatory drugs in combination with anesthetics and other drugs completely eliminate the symptoms of bursitis in 5-7 days. Infectious bursitis should be treated with antibiotic therapy, more severe cases - by surgical intervention.

Bursitis of the hip joint is primarily associated with a large load on the joint during various movements, running and walking, so it is not surprising that this pathology occupies a leading position among other pathologies of the articular apparatus.