What is the treatment for left hip bursitis?

Treatment for Left Hip Bursitis

The treatment for left hip bursitis should begin with conservative measures including NSAIDs, rest, activity modification, and physical therapy, with corticosteroid injections reserved for refractory cases. 1, 2, 3

Diagnosis Confirmation

Before initiating treatment, confirm the diagnosis with:

• Clinical presentation: Lateral hip pain, tenderness over greater trochanter
• Imaging: Initial radiographs to rule out other conditions like hip osteoarthritis 1
• If radiographs are negative or equivocal, MRI or ultrasound may be used to evaluate soft tissue abnormalities 1

Treatment Algorithm

First-Line Treatment

1. Rest and Activity Modification

   • Avoid activities that aggravate symptoms
   • Modify sleeping position to avoid direct pressure on the affected hip

2. NSAIDs

   • Start with naproxen 500mg twice daily or 250mg every 6-8 hours as needed 4
   • Use the lowest effective dose for the shortest duration to minimize side effects
   • Maximum daily dose should not exceed 1000mg after initial treatment 4

3. Physical Therapy

   • Hip girdle muscle strengthening
   • Core strengthening
   • Range of motion exercises
   • Stretching of the iliotibial band

Second-Line Treatment

If symptoms persist after 2-4 weeks of first-line treatment:

1. Corticosteroid Injection
   • Image-guided (ultrasound or fluoroscopy) injection into the trochanteric bursa 1, 5
   • Provides both diagnostic and therapeutic benefits
   • Resolution rates between 49-100% have been reported 5

Third-Line Treatment

For persistent symptoms despite conservative management (typically after 3-6 months):

1. Advanced Physical Modalities

   • Low-energy shock wave therapy has shown superior results compared to other non-operative modalities 5
   • Intensive pulsed ultrasound therapy may help resolve symptoms and calcifications 6

2. Surgical Intervention

   • Reserved for refractory cases not responding to conservative measures
   • Options include:
     • Endoscopic or open bursectomy
     • Iliotibial band release
     • Z-plasty of the iliotibial band
   • Surgical outcomes are generally superior to continued conservative therapy for refractory cases 7, 5

Special Considerations

• Septic Bursitis: If infection is suspected (fever, erythema, warmth), bursal aspiration should be performed for Gram stain and culture, with antibiotics effective against Staphylococcus aureus initiated 3

• Calcific Bursitis: May respond to intensive ultrasound therapy and other conservative measures even with extensive calcifications 6

• Elderly Patients: Use caution with NSAIDs; consider lower doses as the unbound plasma fraction of naproxen is increased in the elderly 4

• Patients with Renal Impairment: NSAIDs are not recommended for patients with moderate to severe renal impairment (creatinine clearance <30 mL/min) 4

Monitoring and Follow-up

• Reassess after 2-4 weeks of initial treatment
• If symptoms persist, progress to second-line treatment
• Consider surgical consultation if symptoms remain refractory after 3-6 months of comprehensive conservative management

The majority of patients with hip bursitis will respond to conservative measures, with only a small percentage requiring surgical intervention. Early intervention with appropriate conservative treatment can prevent progression to chronic bursitis and improve quality of life.