Injecting for trochanteric bursitis
Update your joint injections skills with the latest in our series – this week, we look at trochanteric bursitis
Trochanteric bursitis may occur in rheumatoid arthritis or following minor trauma. The patient complains of pain around the hip, and on further enquiry it is apparent that the pain is felt laterally over the greater trochanter of the femur, worse when lying on the affected side in bed at night. The bursa is fluctuant on palpation and is often multilocular, and situated over the posterolateral surface of the greater trochanter and gluteus maximus muscle.
Consensus opinions of orthopaedic physicians and sports medicine specialists have recently suggested that trochanteric bursitis should be better known as greater trochanter pain syndrome.1
It is suggested that the significant short-term superiority of a single steroid injection over home training and shockwave therapy declines after one month. This condition is a painful overuse syndrome of the hip in adults engaging in recreational sports activities. The anatomical relationship between three bursae, the hip adductor-external rotator muscles, the greater trochanter and the overlying iliotibial tract (band), may predispose this area to biomechanical irritation. MRI studies have shown abnormalities that appear to better correlate with greater trochanteric pain syndromethan any other bursal lesion. These studies showed swellings of the trochanteric bursa to be uncommon – hence the suggestion to label all these conditions of pain around the lateral hip joint as greater trochanteric pain syndrome.
The patient lies on the couch with the affected side uppermost and the hip flexed. At the most tender spot over the trochanter, perpendicularly insert a 2.5cm needle attached to a 10ml syringe until the bone is reached. Withdraw the needle slightly and aspirate the clear yellow fluid. Then, leaving the needle in situ, change the syringe so that 1ml steroid may be injected into the bursa and the tough fibrous insertion of the gluteal fascia.
1 Rompe JD et al. Home training, local steroid injection or radial shockwave therapy for greater trochanter pain syndrome. Am J Sports Med 2009;37:1981-90
This extract is taken from Joint and Soft Tissue Injection 5th Edition, by Dr Trevor Silver which is now available to purchase from Radcliffe Publishing with an exclusive 20% discount available until 30th September – simply quote PULSETS12.
- Confidently diagnose conditions of the joints and soft tissue.
- Understand the benefits and pitfalls of steroid injections.
- New content – sports physiotherapy, elbow joint, iliotibial band syndrome and updates on greater trochanter pain syndrome.
This book has been adapted into an interactive app, bringing to life the high-quality illustrations and diagrams. It allows you to effortlessly navigate through the detailed explanations of technique.