From the Guidelines
Hip bursitis should be initially managed with non-pharmacological approaches, including rest, ice application, and physical therapy exercises, as well as over-the-counter anti-inflammatory medications like ibuprofen or naproxen, with corticosteroid injections considered if symptoms persist beyond 2-3 weeks. Hip bursitis is inflammation of the fluid-filled sacs (bursae) that cushion the hip joint, causing pain on the outside of the hip that may radiate down the thigh. For treatment, start with rest, ice application for 15-20 minutes several times daily, and over-the-counter anti-inflammatory medications like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) 1. Avoid activities that worsen pain for 1-2 weeks. Physical therapy exercises focusing on hip strengthening and stretching are beneficial; try gentle stretches like the figure-four stretch and hip abductor strengthening exercises daily. For sleeping comfort, place a pillow between your knees.
Some key points to consider in the management of hip bursitis include:
- The use of ultrasound (US) to detect trochanteric bursitis and other findings, with US-guided injections of lidocaine or corticosteroids considered for diagnostic and therapeutic purposes 1.
- The importance of addressing underlying causes of hip bursitis, such as repetitive movements, muscle imbalances, or direct trauma, to prevent recurrence.
- The potential for corticosteroid injections to provide immediate relief for symptoms that persist beyond 2-3 weeks, with surgical removal of the bursa (bursectomy) considered in severe cases that do not respond to conservative treatment after several months.
It is essential to note that the management of hip bursitis should prioritize non-pharmacological approaches and over-the-counter medications initially, with more invasive treatments considered only if symptoms persist. Additionally, the use of imaging modalities like US and MRI should be guided by clinical suspicion and the need for further evaluation or intervention 1.
From the FDA Drug Label
For relief of the signs and symptoms of bursitis Naproxen tablets are also indicated: For relief of the signs and symptoms of bursitis Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis The naproxen tablet is indicated for the relief of the signs and symptoms of bursitis.
- The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
- The initial total daily dose should not exceed 1250 mg of naproxen.
- Thereafter, the total daily dose should not exceed 1000 mg of naproxen 2, 2.
From the Research
Definition and Treatment of Hip Bursitis
- Hip bursitis, specifically trochanteric bursitis, is a common orthopedic condition characterized by lateral hip pain, which can be debilitating in chronic or recalcitrant situations 3.
- The condition typically responds to conservative measures, including rest, activity modification, physical therapy, anti-inflammatory medication, or corticosteroid injections 3, 4.
Conservative Management
- Conservative management is the most common initial treatment for hip bursitis and often results in resolution of symptoms and improved patient outcomes 3.
- Corticosteroid injection is a primary treatment modality, with symptom resolution and the ability to return to activity ranging from 49% to 100%, often used in conjunction with multimodal conservative therapy 4.
- Low-energy shock-wave therapy (SWT) has been found to be superior to other nonoperative modalities in comparative studies 4.
Surgical Options
- For patients with persistent symptoms despite exhaustive conservative modalities, surgical options such as trochanteric bursectomy, longitudinal release of the iliotibial band, and repair of gluteus medius tears are available 3, 4.
- Recent advances in hip arthroscopy have allowed for improvements in minimally invasive techniques to address intracapsular and extracapsular pathology of the hip, including recalcitrant trochanteric bursitis 3.
- Surgical techniques have been found to be effective in refractory cases, with efficacy varying depending on the clinical outcome measure 4.