Diagnosis of Hip Bursitis

The diagnosis of hip bursitis (trochanteric bursitis) is normally made after careful questioning and a thorough physical examination. Typically there is pinpoint tenderness on the outside of the hip over the bony prominence known as the greater trochanter. Sometimes there is pain in the buttock, which can extend down the outside of the thigh but rarely below the knee.

If the pain spreads below the knee and particularly if there is associated pins and needles or numbness, the clinician may be suspicious of a spinal problem. If pain is felt in the in the groin it is possible there may be an underlying hip problem.

As well as the location of the hip pain, the clinician will want to know the history of the pain, whether there are any particular activities which make the hip pain worse and whether it is worse at any particular time, day or night. The clinician will also want to know about your general health and whether there is any relevant medical history.

The physical examination is likely to include an examination of the low back because pain over the outer hip may have referred from the spine, this is particularly important if there are neurological symptoms such as pins and needles or numbness in which case a neurological examination will be performed where the clinician tests the sensation, muscles strength and reflexes in the leg.

Invariably the clinician will want to examine the hip joint itself. Normally pain emanating from the hip will cause groin pain and pain at the front of the thigh but not always. The clinician will examine the range of movement of the hip looking primarily for pain and stiffness. Usually in hip bursitis the movements of the hip are normal although it is of course possible there may be an underlying problem with the hip such as osteoarthritis, as well a hip bursitis.

Often in hip bursitis there is weakness to muscles in the leg, particularly the gluteal muscles. An experienced clinician may pick up gluteal weakness simply by watching the walking pattern. They may also ask the patient to stand on the affected leg to see if the muscles around the hip are strong enough to keep the pelvis level. If the muscles are not strong enough the pelvis drops; this is known as a positive Trendelenburg sign.

The final part of the examination normally consists of palpating (or pressing) on the painful area. If the examination of the hip joint and lumbar spine is normal and there is pinpoint tenderness over the greater trochanter with or without gluteal weakness, the diagnosis of hip bursitis is confirmed.

Normally a simple clinical examination is sufficient to confirm the diagnosis of hip bursitis (trochateric bursitis). Further investigations such as x ray or MRI are normally not necessary unless there is thought to be another underlying problem such as an arthritic hip, or unless the patient has not responded to appropriate physical therapy treatment.