Teags - you're getting lots of help here, nice to have a forum. True bursitis is to be distinguished from SI joint issues. One usually refers to the Trochanteric Bursa when referring to hip bursitis but actually there are a number of bursae (bursas) around the joint. They are not normally visible on xray. The sacroiliac joint, although labeled a joint, has hardly any motion to it. With more of a sliding action, the joint moves 2-3mm's and can rotate about 3 -5 degrees. Not much. Years ago people described its fit more like interconnecting Lego pieces.

When you talk with your health care provider, in addition to checking muscle strength, sensory, reflexes and the like, a careful examination of the motion of the hips and spine, comparing the normal to painful side should help create an accurate picture. Whether or not further testing, xrays, etc. are in order can be decided at that point. If you google trochanteric bursitis, you should get more info than you'd ever wanted and help you help your doc. Good luck.

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John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

Thank you, that's very helpful. I think actually my joint popped back into place last night while I was stretching - something went 'pop' anyways :)

So it's possible I still have bursitis but with more submerged bursa. Are the bursa normally not visible on x-ray visible on ultrasound?

The physio yesterday compared sides - there is a big difference in mobility and strength side to side. I was actually quite surprised.

Teags - asymmetric range of motion of joints is just one part of an exam. Believe it or not, there's quite a large percentage of us with unequal joint motion, limb length or strength. The trick is to put it into a complete history and physical exam and come out with recommendations specific to individual under your care at that moment.

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John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

Hello, I just came across this post from a while back.

I've been struggling with a lingering hip bursitis for years as a result of a bike accident (fell sideways on my hip). Nothing was broken, nothing on x-rays or MRIs, it took quite some time for the doctors to get to the bottom of the pain: hip bursitis.
So a year after the accident I had arthroscopy during which a) they found a labral tear b) they took the bursa out (bursectomy). They said if the bursa gives you permanent inflammation it's not doing its job, plus it grows back, anyway. Well, the pain certainly grew back after recovering from that surgery so to me the net effect was zero. That of course is my own subjective experience. Interestingly a cousin from Germany who is an orthopedic surgeon said that hip arthroscopy over there has barely left experimental stages. When I had mine in 2009 in the US I believe it had been around just a few years.

Now this summer I thought I was finally over it and resurrected a lifelong dream to do triathlon. Sure enough, 2 months into training (ie. biking and slowly building up a running program - "couch to 5k" - as I've never run before) I got that nasty pain back, and am resting for now. The orthopedic surgeon back then didn't seem to have any other suggestions other than giving me heavy painkillers/anti-inflammatory drugs with dreadful side effects and perhaps more PT which a year after the accident yielded no further improvements. So now I'm back to square one.

Just curious how your saga ended - given that there were no more posts I sure hope for you that it did. Did you try ART and GRASTON?

Have you had any imaging of your hip? A Primary Care Sports Medicine doctor skilled in Musculoskeletal Ultrasound can evaluate your greater trochanteric area to determine if in fact you have trochanteric bursitis, tendinopathy of the gluteus medius tendon, or other issue. If you are having hip joint issues, an MR Arthrogram of the hip joint is the way to go.

I've had a cortisone shot for my HB which I've had for 6+ weeks now, it's helped a little bit, but that was two weeks ago. 3 questions:

1) how long does it take for the cortisone to take effect?
2) can I run with HB and manage it, as in run, ice, NSAIDs or should I rest it completely until 100% OK?
3) recovery is slow, I'm beginning to think that sitting for 6, 7 hours a day at work could be making it worse? I tend to slouch. Is sitting, especially with poor posture known to exacerbate HB?

Recall, if you aren't getting better it helps to question your diagnosis and or treatment.




I think it was Martin Z. that makes a great point about tears. Perhaps an MRI would be helpful.



Gluteus medius tears are either traumatic or degenerative.



The degenerative tears are part of chronic inflammation of the tendon that results from many small tears over time. They are almost always associated with trochanteric bursitis and often tight ITB friction in the area. In one study of patients with lateral hip pain almost half of them had some sort of gluteus medius tear.


A gluteus medius tear can be graded ==>




Grade 1 strain is mild tear, associated with pain but no loss of motion or strength



Grade 2 strains or partial tears show some loss of flexibility and strength



Grade 3 complete tears, loss of strength and mobility

I didn't see johnpostmd's response before I added my comment.

John always has great advice.

I'm really interested in this: I too suffer from a trochantic bursitis. So bad that some days I oscillate constantly between sitting and standing to relieve the pain.

Localised injections haven't helped, but did offer some short-term relief.

I had a hip bursa issue a few years ago which I believe was caused by and overly aggressive massage a week after an IM. Lived with the pain for about a month and then when to see a physiotherapist/osteopath and got some relief after about 6 weeks. A 6 hour stretch in a car driving kids home after Thanksgiving brought on the pain again to the point that I could hardly walk. The next day I laid down on the couch on my side on top of an ice pack. The next day the pain was gone and hasn't come back.

I started running a week after my shot for hip bursitis. I didn't have symptoms post shot but I started back super slow. Just ease back into the volume and don't be afraid to back off.

 

I have had my own issues with hip bursitis as well.
At the time I was a D1 College athlete and doing winter training in a cold climate. I was running 75-100 mile weeks on the same treadmill. There was 1 TV in the gym which caused me to continually look to my left while running. One day during a long run on the treadmill I felt a sharp pain develop in my left hip. I decided to try to run in off but the pain only worsened.

I decided to immediately take 3-4 days off and try running on it again. After the 4th day I went for a light run and instantly felt pain. I also could no longer sleep on my left side.

I went to the doctor and was diagnosed with hip bursitis. I had a few big races coming up so I pushed the doctor to give me a cortisone shot. The cortisone shot had no effect and I was limited to swimming and cycling. I went to both a physical therapist and a chiropractor. Continuous treatment with both doctors did not seem to have much effect either (although the physical therapist was able to help me with some form issues which has helped me in the long run).

All in all the bursitis took 3 months to fully heal and then I had to come back very, very slowly.

I also saw you had an issue with neuroma. I have recently had an issue on the bottom of my right foot which I believe is neuroma. I don't want to highjack the thread but could you tell me a little about your healing process for that? Any advice? I have 70.3 Santa Cruz in about a month and I am not able to run or bike at this time.

I had a number of races scheduled and diagnosed with hip bursitis with injections which were no help. I had picked up a home remedies book, saw a solution for HP and thought I had nothing to lose so I tried the suggestion and was pain free, back to training without any issues.

Rub castor oil on the impacted area, place a piece of old flannel on the castor oil, put a piece of saran wrap over the flannel and place the heating pad on the area. I was shocked at how well this work.

I now go to a holistic massage therapist who does this same treatment for HP.

I agree with John here. You must rule out spine pathology first and foremost. A lack of range of motion in the joint speaks more to a derangement within the joint (something out of place affecting motion) than just an inflammatory response of the bursa. It is likely that a loss of ROM treated effectively will reduce your pain at the lateral hip than just treating a "bursitis." Find a good mechanical physical therapist who will stretch in an appropriate direction that increases your ROM without making you worse overall.