What Are Trochanteral Bursal Injections?

The hip is a ball and socket joint that is formed by the acetabulum and the femoral head. The greater trochanter is the large bump that is found on the outside of the superior end of the femur. The greater trochanter is the area where the large gluteal muscles connect to the femur. Between the greater trochanter and the tendon that passes over it is a bursa sac.

This bursa sac contains fluids that help to lubricate the joint and reduce friction. When this bursa sac becomes inflamed because of too much friction or because of an injury, it is referred to as trochanteric bursitis.

The pain that is associated with trochanteric bursitis can be severe and can limit an individual’s ability to perform simple tasks such as walking and climbing without pain. A simple and effective treatment that can be used to treat the pain associated with trochanteric bursitis is a trochanteral bursal injection. This injection involves the injection of a local anesthetic, combined with a corticosteroid, into the bursa of the hip joint. A trochanteral bursal injection is a minimally invasive technique that can be performed in an outpatient setting.

How Are Trochanteral Bursal Injections Performed?

Pain-Doctor-Hip-Bursa-Steroid-Injection-Procedure-7The patient is positioned on their good side with the skin over the affected hip exposed.

The patient is usually positioned with the hip flexed 30 to 50 degrees, and the knee flexed 60 to 90 degrees, which helps to increase patient comfort and stabilization.

The hip joint is palpated to localize the painful area. The patient tells the physician when they have palpated the painful area. The physician then marks the tender spot.

The skin of the area to be injected is then cleaned with an antiseptic solution to help prevent infection.

A 22- or 25-gauge, one and one-half-inch needle is inserted deeply into the area.

The needle is inserted directly down to bone and is then withdrawn two to three millimeters before injecting the medication. The injection usually includes a combination of a local anesthetic and a corticosteroid.

After the injection, a bandage may be placed over the injection site.

Pain relief is usually felt relatively soon after the injection, which is due to effects of the local anesthetic.

When the local anesthetic wears off, a patient may experience a slight increase in pain until the corticosteroid begins to take effect.

Pain-Doctor-Hip-Bursa-Steroid-Injection-Procedure-3The duration of pain relief varies from patient to patient. If pain remains after a trochanteral bursal injection, the procedure can be repeated in a month. Some patients may only require one injection for their pain to resolve, however some patients may require two or three injections to experience optimal pain relief.

Patients should be advised to limit activities on the day of their injection. Normal activities may be resumed the day following the injection. Mild soreness after the injection may occur around the injection site. Ice and heat compresses may be applied to the tender area, and over-the-counter pain and anti-inflammatory medications may be used, if needed.

Trochanteral bursal injections are considered a safe and effective treatment option however, as with any procedure, there are certain risks involved, including: bruising, swelling, and inflammation at the injection site, as well as possible bleeding and infection.

Conditions Related To Trochanteral Bursal Injections

Trochanteral-Bursal-1Trochanteral bursal injections are indicated for the treatment of trochanteric (hip) bursitis. The first symptom of trochanteric bursitis is usually pain that can be felt in the hip over the area of the bump that forms the greater trochanter. The pain may radiate into the thigh and, as the condition progresses, patients may report a limp when walking as well as joint stiffness. When there is severe inflammation of the bursa, pain can occur each time the tendon moves over the bone. As the condition progresses, pain may be felt at rest and may result in sleep disturbances.

Diagnosis of trochanteric bursitis usually begins with a medical history and physical examination of the area. Patients will be asked specific questions pertaining to their hip pain. Trochanteric bursitis usually occurs approximately four inches lateral to the hip joint and hurts when the patient lies on the affected hip.

Additionally, patients may report pain with climbing ladders or hills, and when running. Trochanteric bursitis usually does not cause much discomfort with walking. Physical examination may reveal tenderness upon palpation, and sometimes swelling of the affected hip may be seen on examination. A limp may also be present and range of motion of the affected hip may be found during the exam.

If the physician suspects that other conditions may be responsible for a patient’s hip pain, they may order X-rays to rule out other abnormalities in the hip. However, X-rays will not usually show trochanteric bursitis.

Risk factors for trochanteric bursitis include: leg length discrepancies, rheumatoid arthritis, obesity, repetitive stress injury, hip injury, spinal disease, previous surgery around the hip joint, bone spurs or calcium deposits within the tendons that attach muscles to the trochanter, and osteoarthritis. Additionally, friction that result from a tight iliotibial band may result in this condition.

Conclusion

Trochanteral-Bursal-4Trochanteric bursitis is a painful condition that results when the bursa sac around the hip joint becomes inflamed.

Trochanteric bursitis can be caused by acute injuries or repetitive injuries to the hip.

Patients presenting with this condition may report hip pain, joint stiffness, an altered gait pattern, and in severe cases, may report pain at rest and sleep disturbances due to pain.

Trochanteral bursal injections are an effective treatment option for the management of trochanteric bursitis.

Patients experiencing symptoms of trochanteric bursitis are encouraged to speak with their physicians about the possibility of receiving a trochanteral bursal injection for the management of their hip pain.

References

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  3. Cole BJ, Schumacher HR. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg. 2005;13(1):37-46.
  4. Kelly L, Minty L. The occasional injection for trochanteric bursitis. Can J Rural Med. 2011;16(1):20-22.
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