Trochanteric bursa injection is used to diagnose and treat bursitis of the hip. This often presents as pain in the lateral thigh during ambulation. Pain may be elicited by placing the hip in external rotation and abduction.
After obtaining informed consent, the patient is positioned lying on the side and facing the clinician, with the painful hip exposed. The hips and knees are flexed and the affected hip adducted. The protuberance of greater trochanter on the lateral aspect of the thigh is palpated for the point of maximal tenderness. This is usually two fingerbreadths below the tip of the trochanter. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 3-in. (8-cm), 21-gauge needle is inserted perpendicular to the skin at the point of maximal tenderness. The needle is advanced with aspiration attempted until the needle has entered the synovial space. If there is an effusion of the joint, the aspiration is completed. If the aspirated fluid is noninflammatory (clear and viscous), the bursa should be injected with a 3-mL mixture of 20 mg of triamcinolone acetonide (or equivalent) and local anesthetic. If unable to enter the synovial space, the needle is advanced to the bone and then withdrawn 2 mm. After negative aspiration, a 3 mL mixture of 20 mg of triamcinolone acetonide (or equivalent) and local anesthetic is injected (Fig. 67-51).
FIGURE 67-51. Trochanteric bursa injection.
The clinician should consider other causes of pain if the problem persists after bursa injection and appropriate rehabilitation.
Corticosteroids should not be injected if there is any suspicion that the bursa is infected. If the fluid appears infected, it should be sent for culture and sensitivity and the patient treated appropriately for the infection.