Greater Trochanteric Bursa Injection


INDICATIONS
  • Symptomatic individuals with characteristic localized tenderness over the trochanter
CONTRAINDICATIONS
  • Bleeding diathesis
  • Uncooperative patient
  • Bacteremia or cellulitis of the proximal, lateral thigh
TECHNIQUE
    • Position the patient on the examination table with the unaffected hip down and the affected hip up. Drapes can be used to keep the surrounding body areas covered.
    • Palpate over the greater trochanter to reveal the characteristic localized tenderness.
    • After skin preparation, insert a  1 1/2 inch needle to the hub. The needle tip should reach the greater trochanter. If the needle is too short, it may be lengthened by pressing it into the skin .
    • A 10-mL syringe with 1 mL of steroid (e.g., 6 mg of Celestone, 40 mg of triamcinolone) and 6 to 9 mL of 1% lidocaine is used.
      • Injecting a larger volume of fluid appears to be beneficial in the treatment of greater trochanteric bursitis.
    • Inject a small amount just over the initial contact point with trochanter. Redirect the needle around the initial site, and administer additional solution in a wide or fan-shaped pattern. Redirect the needle posteriorly, making sure that the needle tip walks' off the end of the bone, to deliver solution to the portion of the bursa posterior to the trochanter.



     


(1) Anatomy of the lateral hip



(2) Position the patient on the examination table with the unaffected hip down and the affected hip up



(3) Palpate over the greater trochanter to reveal the characteristic localized tenderness.



(4) Insert a long needle to the hub until the tip reaches the greater trochanter



(5) Inject a small amount of steroid and 1% lidocaine just over the initial contact point with the trochanter, redirect the needle around the initial site, and administer additional solution in a wide or fan-shaped pattern