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Section IconTrochanteric Bursitis Injection
Overview
Trochanteric bursitis, or greater trochanteric pain syndrome (GTPS), commonly causes lateral hip pain in adults.
Diagnosis is usually clinical and based on tenderness to palpation of the greater trochanter (in particular, the posterior-superior aspect), pain when lying down on the affected leg, and pain that increases with prolonged standing or ambulation.
The most sensitive test is the resisted external derotation test. Patient should bend leg into figure four and then extend leg into neutral position against practitioner resistance. Pain in the hip is indicative of GTPS.
Trochanteric bursitis is more common in women and in people who are obese.
Injection with both steroids and local anesthetic agents has been shown to improve clinical outcomes at 12 weeks compared to local anesthetic alone.
Ultrasound (US) guidance is not absolutely necessary but can help make the diagnosis and deliver medication to the appropriate location.
Indications
Acute or chronic lateral hip pain with suspicion of trochanteric bursitis/greater trochanteric pain syndrome
Contraindications
Allergy to local anesthetics or steroids
Infection overlying the area
Equipment & Dosing
10-mL syringe
20- to 22-gauge 1.5-in needle; might need 2.5-in needle in larger patients
5 mL of 1% lidocaine or 0.5% bupivacaine, along with 40 mg triamcinolone, 40 mg of methylprednisolone, or other injectable steroid
Procedure & Administration
Have the patient lie on the unaffected side.
Mix the local anesthetic and injectable steroid in one syringe.
Palpate the greater trochanter of the femur.
Sterilize and mark the area.
Anesthetize superficial skin with 1 to 2 mL of lidocaine (optional).
Insert the needle perpendicular to the skin until it makes contact with bone in the area of maximal tenderness.
Retract the needle slightly.
Infiltrate the anesthetic-steroid mixture into the area. Aim to cover an area around 3 cm in size.
Place a small bandage at the injection site.
Charting & Documentation
Obtain and document informed consent.
Document:
  • Aseptic technique
  • NV status before and after procedure
  • Any change in pain
Patient’s ability to ambulate
Special Considerations
No restrictions.
Recommend weight loss, physical therapy, and rest.
Do not perform a second injection earlier than 4 to 6 weeks after the first one.
Videos & Images
Figure 1 Figure 2 Figure 3
Injection - Trochanter (sample) Watch Video
References
  1. Brinks A, van Rijn RM, Willemsen SP, et al. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med. 2011 May–Jun;9(3):226–34.
  2. Canoso J. Greater trochanteric pain syndrome (formerly trochanteric bursitis). Edited by Isaac Z. UpToDate. Published December 2016. Accessed May 2018.
  3. Dean D. Trochanteric bursitis. Edited by Lorenzo C. Medscape EMedicine. Published January 2017.
  4. Lustenberger DP, Ng VY, Best TM, et al. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. 2011 Sep;21(5):447–53.
  5. Segal NA, Felson DT, Torner, JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. 2007;88(8):988–92.
  6. Mallow M, Nazarian LN. Greater trochanteric pain syndrome diagnosis and treatment. Phys Med Rehabil Clin N Am. 2014 May;25(2):279-89.
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