Bursitis is a term that describes inflammation of a bursa- the small sacks that surround joints.
One of the more common conditions that causes pain in the front of the hip is iliopsoas bursitis. This is particularly common in active people who exercise regularly.
The iliopsoas muscle originates from the inside of the pelvis as well as the lumbar spine. This muscle inserts onto a small bony ridge on the upper femur (upper leg bone.)
The iliopsoas bursa is a small fluid filled sac that lies just behind the iliopsoas muscle and in front of the hip joint. Its purpose is to provide cushioning for the hip joint as well as to ensure proper gliding of the tendons adjacent to it.
As with many types of bursae, inflammation can affect the iliopsoas bursa. When this occurs, the patient will experience pain in the groin as well as the front of the thigh. The pain is aggravated by flexing (bending) the hip. Activities such as walking, running, and climbing stairs can be painful. Another maneuver that can provoke the pain is hyperextending the hip.
Sometimes patients may hold their leg with the hip slightly bent and the foot turned out in order to minimize discomfort. Patients may also have a limp.
On examination, there is tenderness when pressure is placed directly over the front of the hip. In several cases, the bursa may be swollen.
While overactivity or trauma may be the most common cause of this type of bursitis, arthritis can also lead to iliopsoas bursitis.
Between 15 and 20% of the time, the bursa communicates with the hip joint. In situations like this, it is sometimes difficult to differentiate whatever the discomfort is coming from the bursa versus the joint.
The diagnosis is suspected by taking a careful history and doing a careful physical examination. The clinical impression can be confirmed by either magnetic resonance imaging or diagnostic ultrasound.
The treatment for this condition is usually conservative to start with. Non-steroidal anti-inflammatory drugs and physical therapy may be helpful.
Ice may also be palliative.
Aspiration of fluid from the bursa and simultaneous injection of glucocorticoid using ultrasound guidance can be curative. On rare occasion, the bursitis may return. If the bursitis does recur, aspiration followed by needle fenestration and injection with platelet rich plasma (PRP) may be effective.
If the bursitis recurs repeatedly, surgery may be required. Fortunately, this is an infrequent occurrence.