Introduction

Hip pain is a common problem that can come from many different causes. Determining the exact cause of the pain is crucial so you can receive the appropriate treatment. If your hip pain hasn’t gone away, understanding what might be behind it can help you work with your doctor to find the best solution. This article will explore the differential diagnosis of hip pain, with a focus on distinguishing trochanteric bursitis and how it compares to other possible sources of hip pain.¹

Understanding the cause of your hip pain

Hip pain can come from many parts of the body, such as the bones, muscles or nerves. One often overlooked cause is trochanteric bursitis, which happens when a small fluid-filled sac on the side of your hip becomes irritated. Knowing how bursitis is different from other types of hip pain can help you get relief sooner.²

What is trochanteric bursitis?

Hip bursitis is when the hip's bursa, the outer sac filled with fluid that helps reduce friction between the muscle, bones and tendons, swells up. This issue is often caused by repetitive hip movements, injury, or health problems, such as rheumatoid arthritis.³

Symptoms of trochanteric bursitis

You might have trochanteric bursitis if you notice: 

• Pain on the outside of your hip, especially when lying on that side
• More pain after walking, standing for a long time, or climbing up stairs
• Tenderness or soreness when you touch the side of your hip
• Swelling or a sensation of warmth over the painful area⁴

These symptoms can make everyday activities uncomfortable, but there are treatment options that can help.

How to differentiate trochanteric bursitis from other conditions

Since hip pain can arise from several causes, it's essential to differentiate trochanteric bursitis from other conditions, such as osteoarthritis, hip labral tears, and sciatica.

Hip osteoarthritis

This condition is caused by a degeneration of the cartilage within the hip joint.^5,6 Its symptoms include:^5,6

• Stiffness
• Deep joint pain
• Reduced range of motion 
• Grinding sensation (crepitus) 

Hip osteoarthritis differs from bursitis in the location of the pain. It comes from inside the hip joint and not the outer side. Additionally, it gets worse with long-term activity.⁷

Hip labral tear

This condition is characterised by damage to the cartilage lining the hip socket, often due to trauma or repetitive movements.⁸ Its symptoms include:

• Sharp pain in the groin or hip
• Clicking or locking feeling
• Instability⁸

Unlike in bursitis, labral tears have mechanical symptoms, such as locking or catching, that are not found in bursitis.⁸

Sciatica (lumbar radiculopathy)

This condition is characterised by compression of the sciatic nerve due to herniated discs or spinal stenosis. It is usually felt on the lower back. Its symptoms include:⁵

• Pain radiating from the lower back to the leg 
• Numbness
• Tingling 

Unlike in bursitis, the pain starts in the lower back and runs down the leg and it is not just localised in the hip.⁵

Hip fracture

This serious problem is usually caused by trauma or weakened bones due to osteoporosis. It is characterised by:¹

• Sudden sharp hip pain
• Inability to bear weight on the affected hip
• Visible deformity

Unlike in bursitis, the pain is sudden and is often severe; you may not be able to move your leg.³

Piriformis syndrome

This syndrome is caused by the compression of the sciatic nerve by the piriformis, a tight muscle in your buttocks. The main symptom is a pain felt in the buttocks that can radiate down the leg. It is often mistaken for sciatica.³

It differs from bursitis in that the pain is concentrated in the buttocks rather than the side of the hip.

Diagnostics approach

To differentiate these conditions, healthcare providers may use:

• Consultation: ask about symptoms
• Physical Examination: checking for tenderness, range of motion, and gait abnormalities⁹
• Imaging Tests: X-rays to rule out fractures or arthritis, MRI scans for soft tissue injuries, and ultrasound for bursitis²
• Injection test: A corticosteroid injection into the bursa can confirm the diagnosis if it relieves pain²

Treatment options

For trochanteric bursitis

• Rest: Avoid repetitive hip movements³
• Ice: a non-pharmacological options to reduce pain and inflammation
• Physical therapy: strengthening exercises for the hip and core muscles to reduce strain³
• Medications: NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen, to reduce pain and inflammation³
• Corticosteroid injections: to help reduce pain and swelling 
• Surgical intervention: rarely required, only if other treatments are ineffective³

For other conditions

• Hip osteoarthritis: lifestyle changes, weight management, and, in severe cases, joint replacement³
• Hip labral tear: physical therapy, injections, or surgery³
• Sciatica: spinal decompression, physical therapy, and pain management³
• Hip fracture: surgery or hip replacement³
• Piriformis syndrome: stretching, physical therapy, and, in some cases, injections³

Summary

Hip pain on the side is often caused by trochanteric bursitis, but other issues like joint wear, torn hip labrum, or sciatica. Seeing what makes the symptoms different by using tests, and using the right care steps can help take care of it well. If your hip keeps hurting, see a doctor to find out what's wrong and get a plan that's right for you.

FAQs

Can hip bursitis heal on its own?

Yes, mild cases often get better with rest, ice, and over-the-counter pain medicine. More stubborn cases might need therapy or an injection from your doctor.

How long does it take to get better?

Healing time can differ; mild cases may get better in a few weeks, but long-term cases could take months.

When should I see a doctor? 

Go to the doctor if the pain is bad, keeps up, or comes with swelling, redness, or trouble putting weight on it.

What moves should I avoid?

Try to avoid activities such as running, jumping, or standing for long periods. Going up stairs can also make things worse.

Can trochanteric bursitis be confused with sciatica?

Yes, both can cause hip pain. But, sciatica usually sends pain down your leg, whereas bursitis pain stays near the outer hip.