Trochanteric Bursa Injections

What is a Trochanteric Bursa Injection?

A trochanteric bursa injection is a minimally invasive procedure in which medicine is injected directly into the trochanteric bursa in the hip joint using a thin needle and syringe to relieve pain and inflammation. The injection usually contains a combination of numbing medicine and cortisone (an anti-inflammatory agent). Trochanteric bursitis, also known as greater trochanteric bursitis or hip bursitis, is the main indication for a trochanteric bursa injection.

Anatomy

The bony prominence of the hip is called the greater trochanter and is present on the outer side of the upper thighbone or femur. The bursa overlying it is called the trochanteric bursa. Bursae are fluid-filled sacs present in the joints between bone and soft tissue that reduce friction and provide cushioning during movement. Trochanteric bursitis is a painful condition caused by the inflammation of the trochanteric bursa in the hip. The condition causes pain in the outer portion of the upper thigh.

Indications for Trochanteric Bursa Injections

Trochanteric bursitis is the primary indication for trochanteric bursa injections. Some of the risk factors that increase the chances of developing trochanteric bursitis include:

• Repetitive stress or overuse injury to the hip bursa due to sports activities, such as football and soccer
• Traumatic injury to the bursa due to a fall or blow to the hip or from lying on the same side of the body for a long period
• Leg length discrepancy may affect your walking pattern and can cause irritation of the hip bursa
• Disease conditions, such as gout, rheumatoid arthritis, and osteoarthritis, may cause inflammation of the bursa
• Bone spurs or calcium deposits formed in tendons that attach to the trochanter may cause irritation of the bursa
• Previous hip fracture surgery or prosthetic implants in the hip can cause irritation of the bursa

Preparation for Trochanteric Bursa Injections

Pre-procedure preparation for trochanteric bursa injections will involve the following steps:

• A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to the procedure.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for some days prior to surgery.
• You should refrain from alcohol or tobacco at least 24 hours prior to the procedure.
• Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
• A written consent will be obtained from you after the procedure has been explained in detail.

Procedure for Trochanteric Bursa Injections

The procedure is performed in an outpatient setting under local anesthesia. You will be asked to lie down on an X-ray table in a position that gives your doctor easy access to the hip joint. The area where the injection needs to be given is numbed with an anesthetic. A small needle is then accurately placed by your doctor into the bursa guided by real-time X-ray images (fluoroscopy). Before injecting the medicine, a contrast dye is injected through this needle into the joint to confirm that the medicine reaches the inflamed bursa. A combination of anesthetic and anti-inflammatory cortisone is then slowly injected into the bursa. A small dressing is then applied over the injection site to complete the procedure. The whole procedure usually takes about 30 to 60 minutes.

Post-procedure Care and Recovery

In general, trochanteric bursa injections will involve the following post-procedure care instructions:

• You will be transferred to the recovery area to be observed for 30 minutes for any allergic or anesthetic reactions as you recover.
• Most individuals are able to walk, eat, and drink post procedure and can go home once stable.
• You may experience some pain, swelling, and discomfort in the treatment area. Pain and anti-inflammatory medications and cold packs are recommended as needed.
• Protect the injection site for a couple of days. Do not use a hot tub, whirlpool, or a bathtub for 2 days; however, it is okay to shower.
• You should be able to resume all your normal activities soon after the procedure.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications of Trochanteric Bursa Injections

Trochanteric bursa injections are a relatively safe procedure. However, there may be certain risks and side effects associated with the injection and corticosteroid medication used. These include:

• Infection
• Bleeding
• Pain and swelling
• Nerve damage
• Skin discoloration
• Tendon rupture
• Local thinning of the skin
• Allergic/anesthetic reaction
• Fever
• Headaches
• Water retention
• Flushed face
• Insomnia
• Increased appetite
• Increased heart rate
• Elevated blood sugar levels in diabetics