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The hip is the largest joint in the body and contains a complicated network of musdes, nerves, blood vessels, ligaments, and tendons.
When tendonitis occurs in the hip it may occur in a number of different areas. The back of the hip is the connection point for a number of different muscles including the external obturators, pyriformis, gemelli, and gluteus medius.
Tendonitis in these areas is felt in the back of the hip and buttocks and is often confused for low back syndromes such as sciatica.
At the side of the hip lies the trochanteric bursa- the largest bursa in the body- sits on top of the iliotibial band, a thick piece of connective tissue that runs from the outside of the hip along the outer leg down past the lateral condyle of the femur, and attaches to Gerde’s tubercle on the tibia. When the iliotibial band becomes inflamed in the hip, it can mimic trochanteric bursitis. Iliotibial band tendonitis usually occurs in runners but may also occur in the weekend athlete.
Pain in the front of the hip may occur as a result of iliopsoas tendonitis. This form of tendonitis is aggravated by flexion (bending) of the hip and is also common in runners. Iliopsoas tendonitis is frequently accompanied by bursitis in the iliopsoas bursa.
Finally, the muscles responsible for bringing the leg in towards the midline- the adductors- are also not spared from developing tendonitis. Patients will complain that the motion of bringing the leg in towards the other leg is painful.
All forms of tendonitis in the hip need to be diagnosed properly and then treated with a combination of non-steroidal-anti-inflammatory drugs, ice, moist heat, and physical therapy.
Patients who don’t respond to these measures may require tendon sheath injection with glucocorticoids.
In cases where the more conservative approach does not work, patients may require the institution of ultrasound-guided percutaneous needle tenotomy with autologous tissue grafting. This is a relatively new approach to the treatment of tendonitis that actually heals tendon tissue.
This procedure needs to be done by a skilled practitioner because of the multiple nerves and blood vessels that inhabit the hip region.