Hip pain is not always caused by arthritis. In fact, inflammation of the bursa (bursitis) and tendons (tendinitis) around the hip joint are even more common causes of painful hips.
Bursitis and tendonitis in the hip cause pain directly over the bone on the outer side of the hip. “Typically, people notice pain when they sleep on the affected side,” says Cleveland Clinic Orthopaedist Michael J.Star,MD.
Pain also may be felt with prolonged sitting, walking or engaging in strenuous activity. The pain can go down the side of the thigh toward the knee.
Dr. Star notes that the source of these symptoms may be an inflamed bursa, an inflamed tendon or both. It may not be possible to tell the difference. It also may not matter because the two conditions are diagnosed and treated the same way.
Bursae and Tendons
Bursae are small sacs located near joints that facilitate gliding of tendons over bones. There are two at the hip. Bursitis most often affects the one near the top and outside part of the thigh bone. This bony point at the hip is called the greater trochanter. The bursa in this location can become irritated or inflamed (trochanteric bursitis).
Tendons are fibrous bands that connect muscle to bone. Like bursae, tendons can become irritated and inflamed.
There usually is no direct cause of inflammation of these structures. “It’s a result of overuse,” says Dr. Star. It can come on suddenly or slowly over time. “Often there’s no injury, people just notice it,” he says.
“People often see a doctor concerned that they have arthritis,” says Dr. Star. The location of the pain can help determine the cause of symptoms. With osteoarthritis in the hip, pain is felt in the groin. If pain is in the buttocks, it probably stems from a problem in the low back. Pain that travels below the knee has a cause other than bursitis or tendonitis.
These features will be used to help make the diagnosis. In addition, the doctor will feel the area for the presence of tenderness. X-rays will be done to rule out other causes, such as osteoarthritis. With bursitis and tendonitis, X-rays will be normal. But it is possible to have both arthritis and inflamed bursae and tendons.
Treatment for bursitis and tendinitis at the hip starts with modifying activity. “Avoid anything that causes pain to flare up,” says Dr. Star. He also recommends sleeping on the unaffected side.
A short course of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve), can be used as long as there are no reasons not to take them. NSAIDs should be used cautiously in certain people, including those with a history of stomach ulcers, kidney disease, heart disease or stroke. Talk to your doctor to ensure you are taking the drugs safely. Your doctor also may prescribe a stronger NSAID.
If pain doesn’t ease up, physical therapy can be beneficial. A corticosteroid injection is also an option. “This doesn’t cure the problem, but it can reduce inflammation and pain, which allows people to do physical therapy,” says Dr. Star.
With these treatments, hip pain should get better in a few weeks, although it can take several months. Sometimes a corticosteroid injection needs to be repeated. “It should be repeated only if it significantly helped the first time and the effect wore off,” says Dr. Star.