What is the initial management for suspected hip bursitis?

Initial Management for Suspected Hip Bursitis

For suspected hip bursitis, initial management should include conservative measures with rest, NSAIDs, and stretching exercises focused on the lower back and sacroiliac joints, followed by corticosteroid injection if symptoms persist. 1

Assessment and Diagnosis

When hip bursitis is suspected, the initial assessment should follow a biopsychosocial approach including:

• Evaluation of physical status: pain location (typically lateral hip), pain characteristics, mobility limitations, and strength 2
• Assessment of impact on daily activities and participation in work/leisure activities 2
• Evaluation of comorbidities and weight that may contribute to symptoms 2

Conservative Management Algorithm

Step 1: First-line Interventions

• Rest and activity modification to reduce inflammation and irritation of the bursa
• NSAIDs for pain relief and inflammation reduction:
  • Oral NSAIDs such as naproxen 500mg twice daily when not contraindicated 3
  • Topical NSAIDs as an alternative with fewer systemic effects
• Physical therapy with specific exercises:
  • Stretching exercises focused on lower back and sacroiliac joints 1
  • Strengthening exercises for hip girdle muscles 2
  • Regular individualized (daily) exercise regimen including isometric strengthening for both legs 2

Step 2: If No Improvement After 2-3 Weeks

• Corticosteroid injection into the inflamed bursa 1, 4
  • Patients whose symptoms persist despite conservative therapy benefit from injection of corticosteroid and local anesthetic 1
  • Studies show 80% resolution rate with corticosteroid injections for trochanteric bursitis 5

Step 3: For Persistent Symptoms

• Reassessment of diagnosis
• Consider referral to specialist if symptoms are severe and refractory to treatment 4
• In rare cases of intractable symptoms, surgical procedures may be considered:
  • Trochanteric bursectomy
  • Iliotibial band release 6

Important Considerations

Weight Management

• If the patient is overweight or obese, weight loss should be addressed as part of the management plan to reduce joint stress 2
• Individualized weight loss strategies should be incorporated 2

Exercise Principles

• "Small amounts often" (pacing) approach to exercise 2
• Link exercise regimens to daily activities to improve adherence 2
• Start with exercises within the individual's capability and gradually increase intensity 2

Assistive Devices

• Consider walking aids (walking stick used on the contralateral side) to reduce pain and increase participation 2
• Evaluate need for assistive technology and adaptations at home/work 2

Common Pitfalls to Avoid

1. Failure to differentiate hip bursitis from other causes of hip pain (arthritis, tendinitis, fracture, nerve pathology) 4

2. Overreliance on imaging - diagnosis is primarily clinical, though radiographs may help rule out other conditions

3. Premature escalation to invasive treatments - most cases respond to conservative management 4

4. Inadequate follow-up - patients should be reassessed after 1-2 weeks of initial treatment to ensure appropriate response

5. Not addressing contributing factors - mechanical issues, activity patterns, and weight should all be addressed for optimal outcomes 2