Trochanteric Bursitis Injection

About this injection

Greater trochanteric pain syndrome (GTPS) — commonly called trochanteric bursitis — is a condition causing pain over the outer hip and lateral thigh. It is caused by inflammation of the trochanteric bursa and/or the gluteal tendons at their attachment to the greater trochanter of the femur.

It is one of the most common causes of hip pain, particularly in middle-aged and older women. Patients typically describe a deep aching pain on the outside of the hip that is worse lying on the affected side, walking on hard surfaces, and climbing stairs.

Corticosteroid injection into the trochanteric bursa provides effective and often rapid pain relief, and is a first-line treatment for GTPS that has not responded to rest and physiotherapy.

Conditions treated

• ✓Trochanteric bursitis — inflammation of the bursa over the greater trochanter
• ✓Greater trochanteric pain syndrome — encompassing bursitis and gluteal tendinopathy
• ✓Iliotibial band syndrome with trochanteric involvement
• ✓Post-hip replacement lateral pain

Symptoms

• —Pain over the outer hip and lateral thigh
• —Point tenderness directly over the greater trochanter
• —Pain worse when lying on the affected side
• —Pain on climbing stairs, walking on hard surfaces, and rising from a low chair
• —Pain radiating down the lateral thigh (not below the knee)
• —Clicking or snapping sensation at the hip (snapping hip syndrome)

Assessment & diagnosis

Examination reveals point tenderness directly over the greater trochanter. The FABER test (Flexion, Abduction, External Rotation) may reproduce pain. Hip joint range of movement is usually preserved — loss of internal rotation suggests intra-articular hip pathology. X-rays are used to exclude hip joint arthritis and fracture.

Treatment options

What happens on the day

1. Clinical assessment and palpation of the greater trochanter
2. Patient positioned in lateral decubitus (lying on unaffected side)
3. Greater trochanter identified and point of maximum tenderness marked
4. Skin cleaned with antiseptic
5. Corticosteroid and local anaesthetic prepared
6. Needle inserted perpendicular to the skin over the greater trochanter
7. Needle advanced to the periosteum, then slightly withdrawn before injection
8. Corticosteroid injected — should flow freely
9. Needle withdrawn, dressing applied
10. Aftercare and physiotherapy advice given

Injection technique

The patient lies on their unaffected side. The greater trochanter is palpated and the point of maximum tenderness identified. A longer needle (green/21G, 40–50mm) is required due to soft tissue depth. The needle is inserted perpendicular to the skin, directed to the trochanteric bursa adjacent to the periosteum of the greater trochanter. Methylprednisolone 40mg or triamcinolone 40mg in 3–5ml local anaesthetic is used to fan the medication across the bursa.

Risks & side effects

• —Post-injection flare — common in the first 24–48 hours
• —Skin depigmentation and fat atrophy — can occur and is cosmetically visible over the hip
• —Sciatic nerve injury — very rare with correct technique and landmark-guided injection
• —Infection — rare
• —Temporary blood glucose elevation in diabetic patients

Aftercare

• ✓Rest and avoid lying on the injected hip for 24–48 hours
• ✓Avoid prolonged walking or stairs for 1 week
• ✓Effect builds over 48–72 hours — do not judge the result for at least 2 weeks
• ✓Begin physiotherapy (hip abductor strengthening) 2 weeks after injection
• ✓Avoid sitting cross-legged or with legs widely apart during recovery

Frequently asked questions