Hip and Shoulder Bursitis in Ajax: Ultrasound Explained

“It’s just bursitis” is a phrase many people hear, often at a walk-in clinic or from a friend who had something similar. It sounds simple and minor, and sometimes it is. But the word covers a family of problems, and the pain people call bursitis is frequently a mix of an irritated bursa, a strained or worn tendon, and sometimes changes in the joint nearby. That mix is exactly why a health-care provider may ask for an ultrasound rather than relying on a label.

This article explains what a bursa is, why the hip and shoulder are the two places it causes the most trouble, what an ultrasound can and cannot add, and how to get ready if your provider has sent you for a scan at our clinic in Ajax.

A small cushion with a big job

A bursa is a thin, slippery sac that sits where tendons, muscles and skin glide over bone. In a healthy state it holds only a very small amount of fluid and is barely noticeable, a little like a smear of lubricant between two moving parts. There are many bursae throughout the body, at the elbow, knee, heel and elsewhere.

When a bursa becomes irritated, its lining can thicken and it may collect extra fluid. That swelling takes up room in places where there is not much room to spare, so movements that used to glide now pinch or rub. The result is pain that tends to follow particular positions or activities.

Common triggers include:

• repeated movements, such as reaching overhead, climbing stairs or long walks on uneven ground
• a direct knock or fall onto the point of the hip or shoulder
• pressure over time, such as sleeping on the same side every night
• changes in how you move because of a stiff back, a sore knee or a difference in leg length
• underlying conditions that affect joints and soft tissues, which your provider may ask about

Often there is no single cause, just a gradual build-up of load that the tissues could not keep up with.

The hip: pain on the outside, not the groin

When people say “hip bursitis,” they usually mean pain on the outer side of the hip, over the bony point you can feel at the top of the thigh. It is often worse when lying on that side at night, getting up from a low chair, climbing stairs or standing on one leg to put on trousers. Some people feel it spread down the outside of the thigh.

Here is where the label can mislead. Health-care providers now recognize that much outer hip pain comes from the tendons of the buttock muscles where they attach to that bony point, with or without a swollen bursa alongside them. You may see this described on a requisition or report as greater trochanteric pain syndrome, which is simply a name for pain in that region, whatever the exact source.

Pain felt deep in the groin or the front of the hip, on the other hand, more often points towards the hip joint itself. That is a different question, and an X-ray may be the more useful first test. Our article on arthritis and what X-rays can show covers that side of things.

The shoulder: a crowded space

In the shoulder, the bursa that usually causes trouble sits between the top of the arm bone and the bony roof of the shoulder, above the rotator cuff tendons. When it swells, lifting the arm out to the side or reaching overhead can produce a catching pain, typically in a band partway through the movement. Lying on that shoulder at night is often uncomfortable too.

Because this bursa sits right on top of the rotator cuff, shoulder bursitis and rotator cuff problems travel together. An irritated tendon can inflame the bursa, and a swollen bursa can crowd the tendon. We have a separate, step-by-step article on rotator cuff ultrasound that describes the arm positions used during a shoulder scan, so we will not repeat them here. What matters for this article is that the same scan looks at both the bursa and the tendons together.

What ultrasound brings to the question

Ultrasound uses sound waves, not radiation, and shows soft tissues such as tendons, bursae, muscles and fluid. For bursitis, its strengths are quite specific.

It shows fluid and thickening

A sonographer can see whether a bursa looks thicker than expected or holds more fluid than usual. They can measure it and record images for the radiologist, who writes the report for your provider.

It looks at the neighbours

Because the probe can be moved freely, the scan can assess the tendons next to the bursa in the same visit. In the hip, that means the buttock-muscle tendons; in the shoulder, the rotator cuff and the biceps tendon. The report may describe tendon thickening, small tears or calcium deposits in the tendon, which often explain as much of the pain as the bursa does.

It can watch movement

An X-ray is a still picture. Ultrasound is live. In the shoulder especially, the sonographer may ask you to move your arm slowly while they watch how the bursa and tendon pass under the bony roof. That can show whether tissue bunches up or catches during the motion that hurts.

It compares sides

It is common for the sonographer to look at the other hip or shoulder for comparison, even if it does not hurt. Bodies vary, and the healthy side is a useful reference.

What ultrasound will not show

No test answers everything, and it helps to know the limits before you go in.

• Ultrasound cannot see inside bone or deep within the joint very well. If your provider is wondering about arthritis, a fracture or the shape of the bones, an X-ray is often ordered alongside or instead. Our article on ultrasound versus X-ray explains the difference in more depth.
• A scan describes what the tissues look like, not how much they hurt. Some people have visible changes and little pain, while others have significant pain and only modest findings.
• The report does not, on its own, decide treatment. Your provider brings the findings together with your history, examination and goals.

Signs that need prompt care instead of a scan

Most bursitis builds slowly and is uncomfortable rather than dangerous. A few situations are different and should not wait for a routine imaging appointment:

• a hot, red, swollen area over a joint, particularly with fever or chills, which can mean infection
• severe pain after a fall, or being unable to put weight on your leg or lift your arm at all
• a hip or shoulder that suddenly looks deformed
• numbness, weakness or pain that spreads quickly down a limb

If you have a fever with a hot, swollen joint, or a significant injury, contact your health-care provider urgently or go to an emergency department. Call 911 if you cannot move safely or feel very unwell. A community imaging clinic is not set up to provide emergency care.

Getting ready for your appointment

Musculoskeletal ultrasound generally needs no fasting or special preparation, though your appointment confirmation will tell you if anything different applies.

For a hip scan, wear loose shorts or trousers that are easy to slide down a little at the waist, because the sonographer needs to reach the outer side of the hip. You will usually lie on your side on the exam bed, with the sore side up and a pillow between your knees if that helps.

For a shoulder scan, a tank top or a top you can easily remove works best. You will usually sit on a stool or the side of the bed.

For either one:

1. Bring your health card and the requisition from your provider.
2. Make a note of which movements hurt most, so you can mention them.
3. If you have had an injection or treatment in that area, tell the sonographer roughly when.
4. Allow a little extra time for check-in, especially if moving is slow for you right now. Our ground-floor access and free parking help on painful days.

The gel is warm and the pressure is light. If pressing over the sore spot is uncomfortable, say so; the sonographer can adjust.

Key takeaways

• A bursa is a small fluid sac that reduces friction; when irritated it can thicken and swell.
• Outer hip pain and shoulder pain on lifting the arm are the classic patterns, but tendons are often involved too.
• Ultrasound shows bursae, tendons and fluid in real time, without radiation, and can compare both sides.
• X-ray is better for bone and joint questions; your provider may order one or both.
• Fever with a hot, swollen joint or a significant injury needs urgent care, not a routine scan.

Booking an ultrasound in Ajax

Rossland Diagnostic Clinic provides general and musculoskeletal ultrasound for patients in Ajax, Pickering, Whitby and nearby communities, Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm. If your provider has given you a requisition for a hip or shoulder ultrasound, call us at 905-426-3111 or request an appointment online, and we will confirm any preparation when you book.