Are Ultrasound-Guided Injections Effective for Trochanteric Bursitis?

Summary and Comment |
August 22, 2013

Are Ultrasound-Guided Injections Effective for Trochanteric Bursitis?

  1. Allan S. Brett, MD

The site of injection might determine whether a patient responds.

  1. Allan S. Brett, MD

We often assume that bursitis is the cause of pain and tenderness over the greater trochanter of the hip. Patients with greater trochanteric pain syndrome often receive corticosteroid injections, not necessarily guided by imaging. However, the relevant anatomy is complex: Several different bursae are present, and the anatomy varies from person to person.

In this retrospective single-site study, researchers in Wisconsin reviewed records of 65 patients who received ultrasound-guided trochanteric corticosteroid injections and who returned pre- and postinjection pain questionnaires. Injections were initiated at the site of maximal tenderness in all patients, but the ultimate location of the needle tip was the greater trochanteric bursa (i.e., deep subgluteus maximus bursa) in 41 patients and into the subgluteus medius bursa in 24 patients. Location of the needle tip was at the discretion of injecting radiologists; no anatomic ultrasound findings distinguished between the two groups. Among patients who received injections into the greater trochanteric bursa, pain improved significantly at 14 days (median improvement, 3 points on a 10-point visual analog scale; P<0.01). In contrast, median improvement was 0 among those who received injections into the subgluteus medius bursa.


This study's flaws include nonrandomized assignment of injection sites and exclusion of an unspecified number of patients who did not return surveys. Nevertheless, the findings might explain why response to steroid injections is so variable in clinical practice. Although these injections are easily done in primary care settings, I believe that we should consider referring selected patients for ultrasound-guided injections, if a specialist who is familiar with these landmarks is available. A nice review of greater trochanter anatomy is available online free of charge (Anesth Analg 2009; 108:1662).

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose


Reader Comments (5)

Annie Steele

I am about to receive my second steroid injection; this time by ultrasound guidance; for suspected trochanteric bursitis. The first one 3 months ago did nothing at all. My specialist ordered a second MRI which I understand is not that conclusive. The pain has been waking me up for the past 4 months despite the use of analgesia and more recently sleeping tablets. To make the issue more complex my physio disagrees with the diagnosis; she believes that it is a spinal problem after physical assessment; more specifically L2.
My actual site of the pain is not according to my physio in the area expected. I am forcing myself to walk (as not been advised not to) at least an hour every day by the Nordic walking method. Nordic walking method is helpful for my performance and I hope will keep me mobile.
It is also very good for the state of your mind!
I would like to say how depressing chronic pain is as well as the fact that the healthcare professionals do not work as a team. (My physio coantacted the musculo-skeletal specialist but he just commented that the most common cause for my case is trochanteric bursitis.I think his comment speaks volumes of 'potluck diagnosis'.

Paolo Bini Physician, Unspecified, Città della Pieve, Italy

I agree with both Dr.s Holland and McCormick, but for those few unsuccessful procedures it may prove useful to refer the patient to a specialist for a second shot under Us guidance (so I agree also with Dr Brett..); of course the patient should be accurately informed of the imperfect nature of the medical gestures...

GARY HOLLAND Physician, Family Medicine/General Practice, Seminole, Florida

With a little experience, the trochanteric bursa is easily palpated and injected. The addition of a local anesthetic indicates immediately if the medication is in the proper area. Yes, lets all try to keep the cost of medical care within reason.

Deborah Waroff Other, Other

Had hip injection with ultrasound. Result pleasant but only lasted five days. Actual problem was bone on bone arthritis which ultimately required hip replacement. Had spine injection years later. Bloody useless. Actual problem spondelitholesis (my spelling lacks). Overall on average you would find injections not cost effective, though perhaps occasionally offer pleasant results. Very expensive and not often reimbursed.

ROBERT MCCORMICK Physician, Family Medicine/General Practice, retired

This is yet another example of utilizing the expensive specialist or specialty for a rather common and 90% treatable the FP's OFFICE . One wonders why medical care is so expensive in the USA.

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