Hip bursitis is so painful because it involves the inflammation and swelling of the bursae, fluid-filled sacs that cushion the hip joint, making them tender and sensitive, leading to sharp pain, especially with movement, pressure (like lying on it), walking, or climbing stairs, often alongside irritated tendons and muscles in the area. The inflammation itself, plus the friction from surrounding tissues like the iliotibial (IT) band rubbing against the bone, creates significant discomfort.
In the early stages, the pain is usually described as sharp and intense. Later, the pain may become more of an ache and spread across a larger area of the hip. Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while.
Pain that doesn't go away
Hip bursitis (trochanteric bursitis) may be a sign of a more serious issue. If you continue to have bursitis pain at the hip that has not improved despite extensive treatment, you may have a tear of a muscle located next to the bursa called the gluteus medius.
While it isn't common for the inflamed bursa in your hip to become infected, when it does happen, it's called septic bursitis – and it can be dangerous. See a doctor right away if you have pain and redness at the hip along with fever, chills or nausea.
“Sleeping on your back with a pillow under your knees, or on your side with a pillow between your knees, can help align your hips and reduce pain,” says Dr. Shekhman. Adjusting your position is one of the easiest ways to sleep with hip pain and minimize pressure on the joint overnight.
It can sometimes extend beyond the hip to the outer part of the thigh. Bursitis pain may start out sharp and quite pronounced, then gradually change into a more widespread and persistent ache. Hip bursitis is often worse at night, when lying down puts added pressure on the pelvic area.
Gout, infection, and engaging in activities that involve repetitive hip movements are the most common culprits in hip bursitis. If you're experiencing sharp, shooting, and debilitating pain, swelling in your hip, and fever, you should consider seeking proper treatment from an orthopedic specialist.
You get bursitis when you have inflammation inside a bursa. This increases the amount of fluid in the bursa and makes it expand. The area around the bursa then becomes painful, swollen and hot, which can stop you being able to use that joint or limb properly.
Seek medical care right away
You're not able to move your leg or hip. You can't put weight on the affected leg. Intense pain. Sudden swelling.
Symptoms of septic bursitis include pain over the affected bursa, joint stiffness, swelling, localized tenderness, fever, and if the bursa is superficial, redness and warmth of the overlying skin. Diagnosis of septic bursitis generally involves aspiration and analysis of the bursal fluid.
If you have bursitis, the swollen bursae will show up on an MRI. Musculoskeletal Ultrasound: This special ultrasound uses sound waves to show fluid in swollen bursae.
If symptoms of bursitis or tendinitis persist despite medical treatment and interfere with your everyday activities, NYU Langone doctors may recommend surgery.
Hip Impingement
An impingement can happen when the hip bone and its joints are too close together and are often the result of labral tears or hip osteoarthritis. Pain can then travel from your hip to the front of your thigh and down to your knee.
If left untreated, trochanteric bursitis can lead to chronic hip pain, mobility limitations, and compensatory movement patterns that contribute to further joint strain.
Surgery for hip bursitis is rarely necessary. However, if you have tried all non-surgical treatments and are still having significant trouble, you may need to have surgery to remove the bursa. Today, this can be done arthroscopically, so the procedure is not very invasive and allows for a fast recovery.
Inside each hip, there are two bursa sacs. Bursae are also found in many other joints, including the knees, shoulders, and elbows. Think of them as a cushion—filled with fluid. They keep our joints lubricated and protected as they move.
In surgical drainage,your orthopedic surgeon drains the fluid, particularly from septic bursitis, with the help of a needle to relieve pain and inflammation.
Expert Orthopedic Treatment for Hip Pain
In most cases of bursitis that are brought for treatment at an urgent care clinic, the healthcare provider will recommend an anti-inflammatory medication such as aspirin or ibuprofen for temporary pain relief and to reduce any swelling, but many patients may also require stronger prescription medication or injections ...
Nonsurgical Treatment
If your elbow bursitis is the result of an infection, your orthopedic doctor will perform a needle aspiration to remove the fluid from the bursa. This will help relieve the symptoms you are experiencing and provide a sample to send to a lab for testing.
Chronic bursitis
The same kind of irritation that caused the original inflammation can trigger a new episode. Repeated flare-ups may damage the bursa and reduce your mobility in that joint.
Fluid retention is a big factor in why bursitis gets worse at night. During the day, our bodies move and help keep inflammation down. But when we lie down at night, gravity changes how fluid moves, leading to more swelling. This swelling puts more pressure on the bursa, making pain and discomfort worse.
Medical Imaging to Diagnose Hip Bursitis
MRI scans: An MRI can confirm or rule out other hip pain-related diagnoses by providing a detailed view of the hip's soft tissue. Images from the test can show swollen bursae or damaged tendons.
Mild cases typically resolve in 2–4 weeks with proper rest and treatment, while moderate cases may take 2–3 months. Severe or chronic bursitis can last 6+ months. Knee and elbow bursitis often heal faster (2–4 weeks), while shoulder and hip bursitis may require 6 weeks to 6 months for full recovery.
Doctors at NYU Langone Orthopedic Center can diagnose bursitis and tendinitis during a physical examination, even soon after an injury. If more detail is needed to confirm a diagnosis, doctors may recommend imaging tests, such as MRI scans and X-rays.