Please help my hip!

June 10, 2012 2:40 PM

Severe hip/leg pain diagnosed as bursitis - what else could this be??

You are not my doctor, and this is not medical advice, but I'm seeking ideas I could explore with my doctor for chronic pain that will not go away. I've looked at other threads about bursitis, but I have a couple other symptoms that might make this different.

For over two years, I've had pain that either occurs right at my hip, or down my thigh on the outer front. Sometimes it's both, much of the time it's in my thigh; right now it's excruciating just at my hip. It's aggravated by almost anything - I can't walk, run, bike, or even sit comfortably, and often sitting aggravates it the most (especially in cramped situations like on planes).

I've been through physical therapy twice, the second time for nearly three months. I've had two rounds of cortisone shots that made no difference. I'm at my wit's end. This current flare-up, the result of biking gently for 15 minutes at the gym, is the worst it's been in quite a long time.

I've been to two doctors, and the most recent doctor diagnosed it as trochanteric bursitis (first doctor just called it bursitis). Given that these doctors noted that it doesn't present as classic bursitis and that conventional treatments have failed, I'm just not sure this is the correct diagnosis. They also focus entirely on the hip and ignore the thigh pain, which is often the most intense.

I had an x-ray of the hip/leg and I have an appointment with my doctor to review it, but I'm wondering if there are other possibilities I can explore with him at that appointment. I think I've reached a point where I need to be aggressive in pursuing other treatments, so I'd love to hear ideas about what else I can talk to him about.

Thanks in advance.

posted by Ms. Toad to health & fitness (12 answers total)

What kinds of doctors have you seen?
posted by the young rope-rider at 2:49 PM on June 10, 2012

I saw my G.P. and a Physical Medicine/Rehab doctor.
posted by Ms. Toad at 3:04 PM on June 10, 2012

I know someone who had severe pain in the upper thigh that turned out to be a bulging disc in the spinal column. The severe pain comes from the spinal chord being pinched. Seek out/get referred to an orthopedic surgeon.
posted by bleep at 3:06 PM on June 10, 2012

I was diagnosed with Femoroacetabular Impingement (FAI) after months of seeing doctors who told me that it was bursitis. I actually had a labral tear to boot. Terrible pain. If this is what you have, physical therapy only makes it worse. Mine showed up out of the blue with no injury involved. My quality of life was so bad that I went on a rampage trying to find a doctor who would listen to me. Go see an orthopedic surgeon who specializes in hips. There are 2 very specific range of motion tests that can be done to test for the possibility of this. A normal x-ray will probably tell you nothing and even MRI's are inconclusive. My MRI was "normal" but the damage found during surgery was compared to that of a NFL running back and I am a 40+ largely not athletic woman in good health/weight. I have to run but I'll try to find the YouTube videos of the range of motion tests. And here is a very long forum of people with hip issues. It helped me A LOT. If this is what you have, you need a specialist and even then you need to make sure that they are ACTUALLY listening to you. I ended up having surgery and am much better now. Feel free to memail me!
posted by futz at 3:11 PM on June 10, 2012 [2 favorites]

Yeah, I'd second the FAI / Labral Tear diagnosis--you present with classic symptom patterns. I also second staying away from Physical Therapists. They always want to increase your range of motion, which aggravates the condition.

In short term, a good test to make sure problem is coming from within hip is cortisone shot into the hip itself (not just bursa). If that gives you any relief, then you almost certainly have a problematic hip.

In longer term, definitely see someone who is a hip specialist. If you're on the East Coast, Hospital for Special Surgery (HSS) is a good bet. But it's tricky--though futz had a good experience with the surgery, many others have not. I recommend going into your research with a very critical attitude and with the understanding that you're going to have to be the "General Contractor" for your hip--there are too many conflicting schools of thought on this to be able to go to one expert and totally trust what they tell you. (E.g., I had surgery by Joseph McCarthy, who once the star hip surgeon, but now majority of surgeons don't agree with his approach.)

Good luck,

Jon
posted by Jon44 at 3:38 PM on June 10, 2012 [1 favorite]

P.s., here's a useful site with general hip info:

http://www.bryankellymd.com/hip_kelly_new.html

As a sort of case study of how confusing this all can be, Dr. Kelly is definitely considered one of top guys in the field now, but there's a minority of patients who can't stand him (I'm in that minority just based on getting examined by him). By reading yahoo message boards (on hip impingement) you can get a sense of different people's experiences, which is a big help.

But again, I'd strongly recommend getting the cortisone into the hip as a test (and strongly recommend having it done with ultrasound rather than flouroscopy), then you can get a good quality MRI if the cortisone helps.

(Note, to really see what's going on in the hip, normal MRI's appear not very useful--you have to get one with contrast, or, HSS has special equipment (and great radiologists) that evidently gives phenomenal views of the hip.)
posted by Jon44 at 3:53 PM on June 10, 2012 [1 favorite]

Surprised you haven't had an x-ray of it yet. That would rule out arthritis, which it could very well be. Have an arthritic hip and some the things you mention sound very familiar. First thing I got was an x-ray and had a diagnosis in seconds. Unfortunately the next step is surgery. Been dealing with the pain for upwards of 5 years now.
posted by WickedPissah at 4:17 PM on June 10, 2012

I was initially diagnosed with bursitis. Symptoms were hip pain and a lot of numbness/tingles in the upper thigh area. The pain has mostly gone and the numbness is less noticeable since I stopped wearing a belt when walking long distances. Turns out I actually had meralgia paresthetica which is a nerve problem that can be caused by pressure on a nerve that runs over the hip bone.

Worth checking?
posted by merocet at 4:18 PM on June 10, 2012

Hey, WickedPissah

She says in her post:

I had an x-ray of the hip/leg and I have an appointment with my doctor to review it...

Also, Jon44 has great information that I didn't include in my post. Everything he said is what I went through. And I also agree that there are a lot of not so great outcomes for this type of surgery. Mixed bag. I'll probably end up having my other hip done and I sometimes wonder if a total hip replacement isn't actually the better solution.
posted by futz at 4:37 PM on June 10, 2012

Have you had any bloodwork done? I developed hip-pain-which-wouldn't-go-away in my early 20s, and it turned out to be Ankylosing Spondylitis, which is a type of autoimmune arthritis -- it's linked to a protein called HLA-B27, which will show up in a blood test. There are other conditions which might be revealed by a blood test, too... I'd suggest having one done to see if anything comes up.
posted by vorfeed at 6:25 PM on June 10, 2012

I did a lot of running in college and developed this exact issue. One of the things I remember most was sitting down and standing up resulted in a lot of pain shooting up and down my leg. I assume you've already done some research on bursitis, but basically it's an inflammation that needs to be treated with a strong anti-inflammatory. If this is indeed what you have, then the treatment is an injection of corticosteroid directly into the bursa. For me, this resulted in an exponential increase in pain for about a week, then it subsided. I talked to a few different doctors and none of them recommended surgery, but I don't know how serious yours is compared to what I went through. Hope your case is something simple, but bursitis isn't the worst diagnosis you could have.
posted by princeoftheair at 7:20 PM on June 10, 2012

Hey, Futz, I know. Surprised it took so long is all. First thing the doc had me do before trying to diagnose me.
posted by WickedPissah at 9:58 AM on June 11, 2012