Hip Bursitis Treatment in Raleigh & Cary, NC

Pain along the outside of the hip is commonly referred to as hip bursitis, but the source of lateral hip pain is often more complicated than inflammation of the bursa alone. Many patients with persistent pain also have irritation, degeneration, or tearing of the nearby gluteal tendons. Together, these problems are often referred to as greater trochanteric pain syndrome (GTPS).

At Carolina Nonsurgical Orthopedics, we evaluate hip pain with the goal of identifying the specific structures responsible for your symptoms and developing a treatment plan that addresses the underlying problem whenever possible.

For patients with chronic hip bursitis or gluteal tendinopathy who have not improved with conservative treatment, platelet-rich plasma (PRP) injections may be considered as a nonsurgical treatment option. PRP is particularly relevant when the gluteal tendons—not simply inflammation within the bursa—appear to be contributing to persistent pain.

Our physicians provide nonsurgical orthopedic care at our Raleigh and Cary, NC offices, including diagnostic ultrasound, ultrasound-guided procedures, PRP, shockwave therapy, and other treatment options.

What Is Hip Bursitis?

A bursa is a small, fluid-filled sac that helps reduce friction between tissues. Several bursae are located around the hip. The bursa most commonly associated with lateral hip pain lies near the greater trochanter, the prominent portion of the femur that can be felt along the outside of the hip.

When this area becomes irritated, patients may develop pain and tenderness over the outside of the hip.

However, what has traditionally been diagnosed as "trochanteric bursitis" frequently involves more than the bursa. The gluteus medius and gluteus minimus tendons attach around the greater trochanter and can become irritated or degenerative.

For that reason, physicians increasingly use the term greater trochanteric pain syndrome to describe this collection of problems.

This distinction can matter when choosing treatment. A treatment aimed only at suppressing inflammation may provide temporary relief but may not address an accompanying chronic tendon problem.

What Does Hip Bursitis Feel Like?

Hip bursitis and greater trochanteric pain syndrome typically cause pain along the outside of the hip rather than deep within the groin.

Common symptoms include:

• Tenderness over the outside of the hip

• Pain when lying on the affected side

• Pain when walking for prolonged periods

• Discomfort climbing or descending stairs

• Pain when getting up from a chair

• Pain with running or exercise

• Pain when standing primarily on one leg

• Aching that may extend down the outside of the thigh

• Increased pain after periods of activity

• Difficulty sleeping because of pressure on the affected hip

Symptoms can range from mild irritation to persistent pain that substantially limits exercise, sleep, and daily activities.

Some patients have symptoms in both hips, although one side may be considerably worse.

Is Hip Bursitis Actually a Tendon Problem?

Sometimes.

This is one of the most important considerations in evaluating persistent lateral hip pain.

The gluteus medius and gluteus minimus muscles are important hip stabilizers. Their tendons attach near the greater trochanter, very close to the trochanteric bursa.

These tendons can develop tendinopathy, partial tearing, or degenerative changes. Irritation of the tendon and bursa can also occur together.

A patient may therefore be told that he or she has "bursitis" when the underlying problem actually includes gluteal tendinopathy.

This may help explain why some patients obtain temporary improvement after a bursa injection only to have the pain return.

At Carolina Nonsurgical Orthopedics, our goal is to determine whether your pain is coming primarily from the bursa, the gluteal tendons, another hip structure, or a combination of problems before recommending an injection.

You can learn more about our broader approach to nonsurgical hip pain treatment.

What Causes Hip Bursitis and Greater Trochanteric Pain Syndrome?

There isn't always a single cause.

Symptoms may develop gradually because of repetitive loading of the tissues around the hip or may occur after an injury.

Potential contributing factors include:

• Repetitive walking or running

• Sudden increases in exercise

• Weakness of the hip stabilizing muscles

• Gluteal tendon degeneration

• Direct trauma to the outside of the hip

• Changes in gait

• Overuse

• Certain biomechanical factors

• Previous hip or lower-extremity injuries

• Prolonged pressure on the outside of the hip

Age-related tendon changes may also contribute to chronic symptoms.

Because several different problems can produce pain in this region, simply identifying tenderness over the greater trochanter doesn't always tell us the entire story.

How Is Hip Bursitis Diagnosed?

Diagnosis typically begins with a medical history and physical examination.

Your physician may evaluate where the pain is located, which activities aggravate it, hip strength and range of motion, tenderness around the greater trochanter, and whether the symptoms could be referred from another area.

Imaging may also be helpful.

At Carolina Nonsurgical Orthopedics, diagnostic musculoskeletal ultrasound can be used to evaluate many of the soft tissues around the hip.

Ultrasound may help assess:

• The trochanteric bursa

• Gluteus medius tendon

• Gluteus minimus tendon

• Tendon thickening or degeneration

• Some partial tendon tears

• Fluid around the bursa

• Other superficial soft-tissue abnormalities

Ultrasound also allows the physician to examine structures dynamically and can be used to guide injections precisely when a procedure is appropriate.

X-rays may be useful when arthritis or another bony problem is suspected.

Could My Hip Pain Be Something Other Than Bursitis?

Yes.

Not all hip pain is bursitis, and not all pain felt near the hip originates from the same structure.

Other potential causes include:

• Gluteal tendinopathy

• Gluteal tendon tears

• Hip osteoarthritis

• Hip labral pathology

• Hip impingement

• Proximal hamstring problems

• Muscle injuries

• Referred pain from the lumbar spine

• Other soft-tissue conditions

The location of the pain provides useful clues.

Hip arthritis and certain problems involving the hip joint often cause more prominent groin or anterior hip pain, while greater trochanteric pain syndrome more commonly produces pain over the lateral hip.

Patients with suspected joint degeneration can learn more about nonsurgical hip arthritis treatment.

What Are the Initial Treatments for Hip Bursitis?

Many cases of hip bursitis or greater trochanteric pain syndrome improve without an injection or procedure.

Initial treatment may include:

• Temporary activity modification

• Avoiding repetitive activities that significantly aggravate symptoms

• Rehabilitation and strengthening

• Improving hip and pelvic mechanics

• Gradual return to activity

• Appropriate medications when indicated

• Other conservative measures

Rehabilitation is particularly important when weakness or abnormal loading of the gluteal tendons contributes to symptoms.

The appropriate treatment depends on the diagnosis, duration of symptoms, severity of pain, activity goals, imaging findings, and treatments already attempted.

What About Steroid Injections for Hip Bursitis?

Corticosteroid injections have traditionally been used for trochanteric bursitis because corticosteroids can reduce inflammation and may provide pain relief.

There are circumstances in which a steroid injection can be appropriate.

However, we don't believe every patient with lateral hip pain should automatically receive a steroid injection.

One reason is that persistent lateral hip pain may involve chronic gluteal tendon pathology rather than isolated inflammation of the bursa.

A steroid injection may reduce pain and inflammation without necessarily addressing the underlying tendon degeneration.

This distinction becomes particularly important in patients who have experienced recurrent symptoms or have already undergone one or more steroid injections with only temporary improvement.

For those patients, it may make sense to evaluate the gluteal tendons carefully and consider other nonsurgical treatment options.

Can PRP Be Used for Hip Bursitis?

For appropriately selected patients, PRP may be considered for chronic greater trochanteric pain associated with gluteal tendinopathy.

PRP stands for platelet-rich plasma. It is prepared from a sample of the patient's own blood. The blood is processed to concentrate platelets, and the resulting PRP is injected into the targeted area.

Platelets contain numerous signaling proteins and growth factors involved in the body's normal response to tissue injury.

Unlike a corticosteroid injection, which is primarily intended to suppress inflammation, PRP is used with the goal of supporting a healing response in damaged or degenerative tissue.

That makes PRP particularly interesting when the underlying problem appears to involve a chronically abnormal tendon.

Learn more about our approach to PRP injections in Raleigh and Cary.

PRP for Gluteal Tendinopathy

When patients describe chronic "hip bursitis," one of the first questions we consider is whether the gluteus medius or gluteus minimus tendon is contributing to the pain.

Tendinopathy is different from an acute inflammatory problem.

A chronically degenerative tendon may demonstrate structural changes and may not respond to treatment in the same way as an acutely inflamed bursa.

When gluteal tendinopathy is identified and conservative care has not provided sufficient improvement, PRP may be one option to consider.

PRP isn't appropriate for every patient, and response to treatment varies. The decision should be based on the patient's diagnosis, examination, imaging findings, prior treatments, health history, and goals.

Why Ultrasound Guidance Matters for Hip PRP

The lateral hip contains multiple structures positioned close together.

If an injection is intended to treat a particular tendon or other structure, accurately placing the injectate is important.

At Carolina Nonsurgical Orthopedics, PRP procedures are generally performed using ultrasound guidance when appropriate.

Ultrasound allows the physician to visualize the anatomy in real time and guide the needle toward the intended target rather than relying solely on surface landmarks.

Depending on the patient's condition, the physician can evaluate and target structures such as the gluteal tendons and tissues around the greater trochanter.

This image-guided approach is an important component of our nonsurgical orthopedic practice.

What Happens During a PRP Procedure?

A PRP procedure generally begins with a blood draw.

The blood is processed to separate and concentrate the platelet-containing portion. The physician then prepares the treatment area and uses ultrasound guidance when appropriate to identify the targeted tissue and perform the injection.

The exact procedure varies depending on the condition being treated.

At Carolina Nonsurgical Orthopedics, PRP treatment is individualized rather than assuming every patient with "hip bursitis" requires exactly the same injection.

For example, a patient with predominant gluteal tendon pathology may require a different approach from someone whose symptoms appear primarily related to the bursa.

How Long Does PRP Take to Work for Hip Pain?

PRP is not typically expected to produce the immediate anti-inflammatory effect associated with a corticosteroid injection.

The response generally develops over time.

Some patients notice improvement within several weeks, while others may experience more gradual changes over a longer period. Recovery depends on the condition being treated, severity and chronicity of the problem, activity level, rehabilitation, and individual biological factors.

Patients should understand that PRP is not guaranteed to eliminate pain or regenerate a normal tendon, and not everyone responds to treatment.

The goal is to use PRP selectively when the diagnosis and clinical circumstances make it a reasonable nonsurgical option.

PRP vs Steroid Injection for Hip Bursitis

These treatments work very differently.

Corticosteroid injections are primarily used to reduce inflammation and pain. They can sometimes provide relatively rapid symptom relief.

PRP is an orthobiologic treatment prepared from the patient's blood and is used with the goal of stimulating or supporting the body's healing response.

The question therefore isn't simply, "Which injection is better?"

The more useful question is:

What tissue is causing the patient's pain, and what treatment makes the most sense for that particular problem?

A patient with an acutely inflamed bursa may have different treatment considerations than someone with months of lateral hip pain, gluteal tendon degeneration, and recurrent symptoms after previous treatment.

This is why accurate diagnosis comes before deciding on an injection.

Are There Other Nonsurgical Options?

Yes.

PRP is only one part of nonsurgical orthopedic treatment.

Depending on the diagnosis, patients may benefit from rehabilitation, activity modification, image-guided procedures, and other therapies.

Shockwave therapy may also be considered for certain chronic tendon conditions. Shockwave uses acoustic energy delivered to the treatment area and does not require an injection.

In some cases, treatment strategies can be combined or sequenced based on the patient's response.

The goal isn't to perform the most procedures. It is to determine which treatment—or combination of treatments—is most appropriate for the specific diagnosis.

When Should You See a Physician for Hip Bursitis?

Consider an orthopedic or sports medicine evaluation when hip pain:

• Persists despite rest or activity modification

• Interferes with sleep

• Prevents exercise or normal activities

• Continues to return

• Has not responded to rehabilitation

• Has returned after a previous injection

• Is associated with weakness

• Has been present for several weeks or months

• Has never been clearly diagnosed

Persistent "bursitis" deserves a closer look, particularly if previous treatment has only provided temporary relief.

The problem may involve the gluteal tendons or another hip structure that requires a different treatment strategy.