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Hip bursitis, i.e., trochanteric bursitis.

On the hip, we have two trochanteric bursae, one is called


superficial trochanteric bursa which is on top of the femoral head, i.e., outside the hip joint. The other
one is called deep trochanteric bursa, a deep bursa, which is underneath the gluteus medius muscle.
Hip bursitis are inflamed conditions of hip bursa. The patients with hip bursitis typically complain lot of
hip pain, although the hip joint itself is not involved. The pain very often radiates down to the lateral
aspect of the thigh.
Fig 11.1

The course and risk factors of hip bursitis:


The hip bursitis usually is caused by contusions from falls, contact sports, and/or by the bursal
irritation resulting from friction by the iliotibial pain (ITB).
This condition is most common in the middle aged or elderly, and especially prevalent among women
with the following conditions:
1.

Repetitive activity such as stair climbing, bicycling, standing, running, hiking for long periods
of time.

2.

An injury such as a fall, or lying on the side for long periods of time, exerting unnecessary
pressure on the hip.

3.
4.

Lower back pain, caused by arthritis, scoliosis, spondylosis, etc.


Previous surgery, such as surgery around the hip or total hip replacement which can irritate
the bursa and cause bursitis.

5.

Leg length discrepancy. This will change the center of gravity and cause irritation of the hip
bursa.

The symptoms of hip bursitis include:

1.

Hip pain. The pain sometimes radiates to the outside of the thigh to the knee area, as well as
to the groin area. The pain may be worse during activities such as running or sitting with the leg
crossed over the opposite knee.

2.

The pain may disturb sleep, especially when the patient is lying on her right side.

3.

Swelling may occur from the increased fluid within the bursa.

4.

The condition may cause limping and the patient may have difficulty walking or running.

5.

Heat and redness may occur on the affected bursa.

Hip bursitis usually is not related to osteoarthritis. Therefore, by the MRI or x-ray, you cannot see the
hip spur, bone spur, or narrowing of the joint space. You may also not see the tendonitis around the
hip joint and only see inflamed enlarged bursa. The differential diagnosis of hip bursitis is as
following:
Fracture of the femoral head
1.

Avascular necrosis of the femoral head

2.

hip fracture

3.

Lumbosacral radiculopathy

4.

Iliopsoas tendonitis

5.

ITB tendonitis

6.

Internal snapping hip and external snapping hip, etc.

Western Medicine Treatment:


Most often, physician will prescribe anti-inflammatory medication such as naproxen, Advil, etc.
Usually, there is no significant improvement after taking the naproxen, etc., because the bursitis is
acute and severe inflammation on the bursa of the hip but many patients like to take anti-inflammatory
medication.
1.

Rehabilitation program by physical therapy. Very often, physical therapy should be applied by
stretching of the ITB, tensor fascia lata, external hip rotators, quadriceps, and hip flexors. The
physical therapy modality such as cold pad, electrical stimulation, and soft tissue massage
might be also helpful.

Fig 12.3

Fig 22.4

2. Corticosteroid injection. There are many studies which showed the corticosteroid injection at
the inflamed bursa can have quick, specific, and effective treatment with prolonged benefit.
Usually, the patient should lie on the unaffected side. About 40 mg to 80 mg corticosteroid
with 5 cc of 1% to 2% of lidocaine mixed to inject to the bursa about 66% of patients at a
follow up visit at one year and five years feel much improved.
As an acupuncturist, we should do as the following
Have the patient to rest. Instructed the patient do not perform any repetitive activity for at least one
month, and in the meantime, put ice massage on the hip about 15 minutes to 20 minutes twice a day
on the hip and the ITB. Because the inflammation inside the hip bursa, the fluid very often leaks out
followed the ITB and makes the ITB inflammation. That is why, the pain radiates down to the lateral
thigh. Because of ITB is attached around the knee, the pain will not go down beyond the knee.
Therefore, the massage with ice is a very important procedure to decrease the inflammation and pain.
1.

Acupuncture. The acupuncture usually I choose GB 30 Huan Tiao, Arshi GB31 Feng Shi,
GB34 Yang Ling Quan, Sp9 Ying Ling Quan, Sp10 Xue Hai and Liv3 Tai Chong.

Points
Huan Tiao

Meridan/No. Location
GB 30
At the junction of the lateral 1/3

Function/Indication
Pain of the lumbar region

between the great trochanter and and the thigh, muscular

2.

Feng Shi

GB 31

the hiatus of the sacrum.

atrophy of the lower limbs,

On the midline fo the lateral

hemiplegia
Pain and soreness in the

aspect of the thigh, 7 inch above thigh and lumbar region,

3.

Yang Ling

GB 34

Quan

the transverse popliteal crease.

paralysis of the lower limbs,

In the depression anterior and

beriberi, general pruritus


Hemiplegia, weakness,

inferior to the head of the fibula

numbness and pain of the


knee, beriberi,
hypochondriac pain, bitter
taste in the mouth, vomiting,
jaundice, infantile,

4.

Ying

Sp 9

LingQuan

convulsion
On the lower border of the medial Abdominal pian and
condyle of the tibia, in the

distension, diarrhea,

depression on the medial border dysentery, edema, jaundice,


of the tibia

dysuria, enuresis,
incontinence of urine, pain
in the external genitalia,
dysmenorrheal, pain in the

5.

Xue Hai

Sp 10

When the knee is flexed, 2 inch

knee
Irregular menstruation,

above the medial edge of patella. dysmenorrheal, uterine


bleeding, amenorrhea,
urticaria, eczema,
erysipelas, pain in the
6

Tai Chong

Liv 3

medial aspect of the thigh


On the dorsum of the foot, in the Headache, dizziness and
depression distal to the junction of vertigo, insomnia,
the first and second metatarsal

congestion, swelling and

bones.

pain of the eye, depression,,


infantile convulsion,
deviation of the mouth, pain
in the hypochondriac region,
uterine bleeding, hernia,
enuresis, retention of urine,
epilepsy, pain the anterior
aspect of the medial
malleolus

Fig 22.5
I choose the big diameter needle and with electrical stimulation at the bursa and the big needle
usually can make the swelling going down and increase the energy flow go through the bursa. The
stimulation can repetitively stimulate the bursa making the patient pain sensitivity going down and the
patient will tolerate more the stimulation and the daily activity. Other points such as Hegu and
Taichong will increase large dosage of endorphin secretion which will make the patient feel less pain.
The patient underwent my treatment for about 10 visits and with soft massage, ice, and acupuncture
with electrical stimulation and she feels much better after the treatment. She followed up once after
two months and her hip pain is completely gone.
Tips for Acupuncturist:
Always ask the patient to rest and ice massage, and if you understand some Chinese herb, you can
choose some Chinese herb cream with anti-inflammation function to massage the patients hip and
ITB.
1.

If the patients hip has obvious severe inflammation or infection, do not treat and you should
refer the patients to her or his primary care physicians to check if there is any infection.

2.

A large diameter needle with electrical stimulation will be much more effective than the small
diameter needle without electrical stimulation.

3.

You may teach the patient to stretch the right ITB band and hip joints in a certain way.

Tips for Patients:

Ice massage is very important treatment method, you must use ice to massage your hip 15 min 2x a
day in order to reduce the inflammation and decrease pain.