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Hip News for Patients and Doctors Fooled by "Back Pain"

Posted on: 12/20/2002
Did you know that hip bursitis can mimic back pain? Even though doctors know this, 20 percent of the LBP cases caused by hip bursitis aren't properly diagnosed. There are many possible reasons for this.

Hip bursitis is a painful irritation on the side of the upper part of the hip. A jelly-like sac called the bursa sits between the hipbone and a tendon. It's designed to offer a cushion for the tendon as it slides over the bone. Hip bursitis is part of a larger group of problems called greater trochanteric pain syndrome (GTPS). GTPS is most common in middle age--just about when many vague aches and pains begin.

At first, the symptoms of GTPS may be too hard to pinpoint. This prevents a correct diagnosis. The painful symptoms may move down the thigh to the knee with numbness and tingling present. These symptoms are just like another problem called lumbar radiculopathy. Radiculopathy occurs when pressure from a spinal disc, tumor, or bone spur causes shooting pain and numbness down the leg.

An MRI doesn't always show a problem with the hip bursa. This can work against the patient who really does have a local irritation of the bursa. There are two ways doctors can confirm the presence of GTPS as a cause of LBP. The first is called the "jump" sign. The doctor puts thumb pressure along the bursa on the outside edge of the hip. When GTPS is the cause of painful symptoms, the tendon visibly "twitches" when pressed. This is called a "jump" sign.

Second, the doctor can inject the bursa with a steroid medicine and a numbing agent. At least half of the time, the injection reduces or takes away the pain. This actually confirms the diagnosis of GTPS. Early diagnosis of GTPS can save patients costly and painful treatment, including unneeded operations.

P. Justin Tortolani, MD, et al. Greater Trochanteric Pain Syndrome in Patients Referred to Orthopedic Spine Specialists. In The Spine Journal. July/August 2002. Vol. 2. No. 4. Pp. 251-254.

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