Hip Bursitis, Tendonitis, & Snapping Hip 

The hip is the second most mobile joint in the body. There are many structures surrounding the hip joint which makes it more susceptible to injuries. One of the most common overuse injuries relates to the tendons and bursae (fluid filled sacs to reduce friction) of the upper end of the thighbone. The greater trochanter is the large bump felt along the side of the thigh, just below the hip, which has a couple of bursae attached to it.

The side of the greater trochanter houses a large bursa that lies just under the iliotibial band (ITB). When too much friction occurs from overuse, primarily with excessive hip flexion and extension, the fluid sac wears down and becomes inflamed. Since the bursa is worn down, the tendon becomes irritated because there is more friction which leads to tendonitis. The inflammation can carry over to surrounding tissues making it difficult to differentiate between bursitis and tendonitis. Either way, the treatment is similar.

In the same area, but just slightly below the greater trochanteric bursa is the iliopsoas bursa. This sac reduces friction between the thigh bone and iliopsoas tendon. The same injury can occur from overuse activities such as running or swimming. The iliopsoas tendon is also important because it is often related to another injury commonly called “snapping hip.” The tendon when moved from flexion to extension over the femoral head, the lesser trochanter, or part of the pelvis will cause a snapping sensation. An individual will complain of pain in what is called the femoral triangle.

The femoral triangle is made up of the inguinal ligament which holds the iliopsoas muscle in place, and two muscles: the Sartorius and Adductor Longus. The femoral triangle is important because it not only holds the iliopsoas tendon in place, but also houses the femoral nerve, artery and vein. If inflammation occurs at this site, it can lead to a variety of other problems.

Treatment for all these problems consists of rest, ice, anti-inflammatory medications, and stretching are the initial treatment. For the more severe cases formal physical therapy that includes ultrasound and massage might be necessary. Pain and the tightness usually resolve after a few weeks of treatment, but it is important to continue the treatment for a few more weeks to prevent reoccurrence.

Highlights

  • All conditions can be treated conservatively
  • Surgery is very rarely needed
  • It is sometimes difficult to differentiate between the problem because they are all located close to each other and have similar symptoms

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