When discomfort travels down the leg, it is commonly associated with a pinched nerve. This article will clarify the distinct nature of hip bursitis and sciatica, the reasons their pain patterns can overlap, and the specific steps medical professionals take to accurately identify the source of the problem. Understanding the difference is paramount because effective treatment depends entirely on correct diagnosis.
What Is Hip Bursitis?
Hip bursitis, known as greater trochanteric bursitis, involves the inflammation of a small, fluid-filled sac located on the outer side of the hip. This sac, the trochanteric bursa, cushions the greater trochanter—the bony prominence of the thigh bone—from overlying muscles and tendons. Inflammation typically arises from repetitive activities, direct injury, or underlying conditions that alter walking mechanics, such as leg-length differences or spinal issues.
The primary symptom is a deep ache or sharp, burning pain directly over the outer hip, which is often tender to the touch. This discomfort frequently worsens with activity, such as walking or climbing stairs. It is particularly noticeable when lying on the affected side at night. Although the pain is generally localized, it can sometimes radiate down the side of the thigh, contributing to diagnostic confusion.
What Is Sciatica?
Sciatica describes pain originating from the irritation or compression of the sciatic nerve, the body’s longest nerve, which runs from the lower back down each leg. This nerve is formed by nerve roots exiting the spinal cord in the lower lumbar and upper sacral regions (L4 through S3). Sciatica is a symptom of an underlying condition affecting these spinal nerve roots, most often a herniated disc or spinal stenosis (a narrowing of the spinal canal).
The hallmark of sciatica is a sharp, shooting, or electrical pain that typically starts in the lower back or buttock and travels down the back of the leg. This pain often extends below the knee and sometimes into the foot. It is frequently accompanied by numbness, tingling, or muscle weakness along the nerve’s path, indicating true nerve root dysfunction. Sciatica pain patterns follow a specific neurological pathway, differentiating them from local inflammation.
Why Their Pain Patterns Overlap
Hip bursitis does not cause the spinal nerve root compression required for true sciatica, yet their symptoms frequently overlap in the hip and thigh area. The trochanteric bursa is located close to several nerves, including the main sciatic nerve which runs deeper in the buttock region. Intense inflammation and swelling of the bursa and surrounding tendons can irritate these adjacent nerve branches, leading to referred pain that mimics the deep ache of sciatica.
This radiating pain from bursitis usually follows the outer side of the thigh and tends to stop above the knee. This differentiates it from the classic pattern of true sciatica, which often continues down the leg below the knee. Furthermore, many patients diagnosed with sciatica are later found to have greater trochanteric pain syndrome (GTPS), a diagnosis encompassing bursitis and gluteal tendon issues. Studies show approximately 11% of patients referred for sciatica were incorrectly diagnosed and actually suffered from GTPS. The anatomical proximity and potential for inflammation to spread are the main reasons for this confusing presentation.
Diagnostic Steps and Treatment Focus
Differentiating between these two conditions requires a careful physical examination focusing on the location and nature of the pain. A healthcare professional will look for localized point tenderness directly over the greater trochanter, which is highly indicative of bursitis or GTPS. Specific tests, such as the single leg stance test, may reproduce bursitis symptoms.
In contrast, true sciatica is often confirmed with a positive straight leg raise test. This test reproduces the shooting pain down the back of the leg when the leg is lifted, indicating spinal nerve root irritation. Imaging studies support the diagnosis by ruling out other causes; X-rays eliminate bone issues, and MRI assesses soft tissues and spinal discs. A highly specific diagnostic tool for bursitis is a targeted injection of a local anesthetic and corticosteroid into the bursa. If the pain is immediately relieved, the diagnosis of bursitis is confirmed.
The initial treatment strategies for the two conditions are distinct because they target different pain generators. Bursitis is primarily treated with nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy to correct underlying biomechanics, and local corticosteroid injections to reduce inflammation in the bursa. Sciatica treatment focuses on addressing the underlying spinal problem, often through physical therapy aimed at spinal decompression, activity modification, and sometimes epidural steroid injections to reduce nerve root inflammation.