Hip Bursitis Treatment: How a Hip Ultrasound Can Help

What is hip bursitis?

The bursa most often involved lies over the greater trochanter, the bony point on the outside of the upper thigh. This is why the condition is also called trochanteric bursitis.

UK clinicians increasingly use the term greater trochanteric pain syndrome, or GTPS. This broader diagnosis covers the bursa, the gluteal tendons attaching to the same bone and the thick iliotibial band running down the outer thigh.

The iliopsoas bursa is a different bursa at the front of the hip and usually causes groin pain. This guide focuses on pain over the outer hip.

What are the symptoms of hip bursitis?

Hip bursitis causes tenderness and pain over the outside of the hip, sometimes spreading down the outer thigh towards the knee.

Women are affected considerably more often than men. A 2007 study of 3,026 adults aged 50 to 79 found one-sided greater trochanteric pain in 15% of women and 6.6% of men. It was also more common in people with knee osteoarthritis or lower-back pain, both of which can alter hip loading during walking.

How is hip bursitis diagnosed?

Diagnosis combines a clinical examination with ultrasound confirmation.

The clinician presses over the greater trochanter to locate tenderness, may ask you to stand on one leg for up to 30 seconds and moves the hip into positions that compress the outer tissues. Reproduction of familiar pain points towards the outer hip.

Examination alone cannot reliably separate the bursa, gluteal tendons and iliotibial band. Ultrasound assesses these structures individually and dynamically.

If the tendons are the main finding, read our detailed guide to gluteal tendinopathy.

What is the best treatment for hip bursitis?

The best treatment combines changing how the hip is loaded with a progressive exercise programme. A corticosteroid injection may help settle pain in the short term.

Changing how you load the hip

Outer-hip tissues become painful when compressed against the bone. Reduce positions that increase this pressure: avoid crossing the legs, hanging body weight on one hip and side sleeping without support. A pillow between the knees helps keep the upper leg level, and a cushion under the hip may make lying on the painful side more comfortable.

Exercise

Exercise has the strongest long-term evidence. The LEAP trial, published in the BMJ in 2018, compared education plus exercise, corticosteroid injection and a wait-and-see approach in 204 people with outer-hip pain.

After one year, 51 of 65 people in the exercise group reported success, compared with 36 of 63 who received an injection and 31 of 60 who waited.

Exercises begin gently, often by tightening the hip muscles while lying or standing still, and progress towards single-leg strength and control over eight weeks or longer. A personalised rehabilitation programme can match these stages to the scan findings.

Corticosteroid injection

A corticosteroid injection can reduce inflammation around the bursa and ease pain within days. It works best as a way to calm symptoms enough for exercise.

An ultrasound-guided corticosteroid injection places the needle precisely into the bursa under direct vision. Greater trochanteric bursitis is treated through the Joint Pain Clinic.

Other options

For symptoms lasting many months despite exercise or injection, some clinicians consider platelet-rich plasma therapy, although evidence for this condition is still developing.

Surgery is rarely required and is generally reserved for persistent cases or significant tendon tears. A consultant orthopaedic assessment is the appropriate setting to discuss it.

How can you heal hip bursitis quickly?

Protect the outer hip from compression while gradually rebuilding strength.

• Keep a firm pillow between the knees at night.
• Stand evenly on both feet rather than resting on one hip.
• Choose higher chairs instead of low sofas.
• Avoid stretches that pull the leg across the body, as these press the painful tissues more firmly against the bone.
• Use swimming, cycling or walking on flat ground to maintain activity when comfortable.
• Reduce hill walking, repeated stairs and long runs during the early painful stage.

Will hip bursitis ever get better?

Most cases improve, although recovery can take several months. In the LEAP trial, just over half of those receiving no specific treatment reported improvement at one year, while approximately four in five of those following the exercise programme improved.

Continuing some strengthening after the pain settles helps reduce recurrence.

What is the best doctor to see for hip bursitis?

See a clinician with musculoskeletal experience, such as a GP, sports medicine doctor, physiotherapist or orthopaedic specialist.

The clinician should examine the hip carefully and, when the diagnosis is uncertain, confirm the affected tissue with imaging before an injection.

What else could cause pain on the outside of the hip?

Several conditions cause pain around the hip, and distinguishing them changes treatment.

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Book a hip ultrasound at London Private Ultrasound

If you have been told you have hip bursitis and want to know which structure is painful before choosing an injection, a hip ultrasound can provide an answer in one appointment.

An MSK specialist examines the bursa and gluteal tendons, moves the hip dynamically, explains the findings during the scan and provides a written report.

This service is for adults aged 18 and over. No GP referral is required. Call 020 7101 3377 or contact the clinic by WhatsApp.

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Clinical guidance and review

This information reflects published clinical research, NHS principles for musculoskeletal care and ultrasound practice aligned with professional BMUS standards. Treatment should be individualised after clinical assessment and imaging when appropriate.