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Greater trochanteric pain syndrome (GTPS) groups several etiologies of lateral hip, buttock, and thigh pain. These etiologies include greater trochanteric bursitis, gluteal medius tendinopathy or tears, gluteal minimus tendinopathy or tears, and iliotibial band snapping. Patients may have coexisting bursitis and tendinopathy. While greater trochanteric bursitis is a self-limiting process, it can cause significant pain and functional impairment. Although conservative management with NSAIDs, activity modification, physical therapy, and weight reduction is often successful, corticosteroid injections of the trochanteric bursa are commonly performed to reduce pain and improve functionality. This activity will review the clinically relevant anatomy, indications, contraindications, technique, and complications associated with trochanteric bursa injections. The activity also highlights the role of the interprofessional team in optimizing outcomes for patients with greater trochanteric bursitis treated with intrabursal corticosteroid injection. Objectives: Apply the clinically relevant anatomy to the differential diagnosis of greater trochanteric pain syndrome. Assess patient response to conservative therapy and determine the need for intrabursal corticosteroid injection. Employ best practices when performing a trochanteric intrabursal injection under fluoroscopic guidance. Coordinate follow-up care, monitoring, and additional interventions as necessary for patients receiving trochanteric bursa injections. Access free multiple choice questions on this topic.

Greater trochanteric pain syndrome (GTPS) groups several etiologies of lateral hip, buttock, and thigh pain. These etiologies include greater trochanteric bursitis, gluteal medius tendinopathy or tears, gluteal minimus tendinopathy or tears, and iliotibial band snapping.[1][2] Furthermore, patients may have coexisting bursitis and tendinopathy. Greater trochanteric bursitis is characterized by localized lateral hip pain that typically presents with focal tenderness over the greater trochanter. The pain typically worsens when walking upstairs, standing up from a chair, or lying with the affected side down.[3][4] The most common physical examination finding of greater trochanteric bursitis is pain with palpation over the greater trochanter; this is the key clinical diagnostic indicator differentiating greater trochanteric bursitis from primary diseases of the hip joint, which typically radiate towards the groin. The pain of greater trochanteric bursitis may be exacerbated by active abduction and passive adduction of the hip.[5][6] GTPS is more common in females, patients who are overweight or obese, and patients aged 40 to 60 years. It has been suggested that the larger width of the typical female pelvis may cause increased tension on the iliotibial band over the greater trochanter. In addition, patients with GTPS may have coexisting back pain, hip osteoarthritis, and conditions that alter lower extremity mechanics, such as knee pain resulting in abnormal forces around the hip.[1] GTPS is diagnosed clinically and does not have specific diagnostic criteria. Imaging results are variable and may show bursitis, gluteal tendinopathy, or no bursal inflammation.[7][8]

In general, injecting the trochanteric bursa is considered safe, and the risk of serious adverse effects is low.[12][7] The most common risks to discuss with patients are pain, bleeding, infection, allergic reactions, and injury to adjacent structures. Infection should be considered in the setting of persistent, localized pain associated with erythema or purulent discharge at the injection site, fevers, chills, and other systemic infectious indicators.[4] The overall risk of septic arthritis is less than 0.3 %.[4] Necrotizing fasciitis following injection of the trochanteric bursa is exceedingly rare but has been reported.[12] Common side effects of steroid injection include headache, flushing, insomnia, and elevated blood glucose.[4] Long-term injectable corticosteroid treatment can weaken tendon structures and increase the risk of steroid-induced tendon rupture.[7][4] Steroid flares can mimic septic arthritis and may present as severe localized pain with an increased systemic inflammatory response and a joint effusion. Flares usually present 1 to 3 days following the procedure and last up to 5 days. The steroid flare does not impact the efficacy of the injection and should be treated conservatively with nonsteroidal anti-inflammatory agents (NSAIDs).[4] A corticosteroid injection can cause fat cells at the injection site to atrophy. A depression in the skin may appear because the underlying fat cells have deteriorated.

Injections of the trochanteric bursa are commonly performed to treat pain secondary to greater trochanteric bursitis. The interprofessional approach is critical to maintaining patient safety and optimizing procedure performance. Communication is essential as each healthcare team member plays a role in facilitating patient care. The nurse should bring in the equipment and medications and place appropriate monitors for vital signs. The imaging technician should know the treatment site to position the fluoroscopy machine appropriately. Any questions or concerns about the medications administered during the procedure should be directed toward a pharmacist. After the procedure, the patient should be monitored for any immediate adverse effects or complications. The patient should be instructed that pain relief after the procedure will likely be temporary due to the transient effect of the local anesthetic and that it will take several days for the corticosteroids to take effect. In addition, the patient should be educated on common issues after the procedure, such as local site tenderness and any signs or symptoms that warrant medical attention. The patient should also be advised to avoid prolonged submersion in water for 24 hours.[4] The clinician who performed the procedure should be available to answer any questions or concerns before patient discharge. An interprofessional approach provides the best patient outcomes.