Gluteal Bursa Injection

Chronic bursitis

Causes and findings:
• Overuse
• Pain and tenderness over the upper lateral quadrant of the buttock
• Painful: passive flexion, abduction and adduction resisted abduction and extension
• End-feel normal

Equipment:
Syringe - 5ml
Needle - 22G 3.35 inches (90mm) spinal
Kenalog 40 - 40 mg
Lidocaine - 4 ml 1%
Total volume - 5 ml

Anatomy:
The gluteal bursae are variable in number, size and shape. They can lie deep to the gluteal muscles on the blade of the ilium and also between the layers of the three muscles. The painful site guides the placement of the needle but comparison between the two sides is essential as this area is always tender.

Technique:
• Patient lies on unaffected side with lower leg extended and upper leg flexed
• Identify and mark centre of tender area in upper outer quadrant of buttock
• Insert needle perpendicular to skin until it touches bone of ilium
• Inject solution in areas of no resistance while moving needle in a circular manner out towards surface - imagine the needle walking up a spiral staircase

Aftercare:
The patient must avoid overusing the leg for a week and can then gradually resume normal activities. Addressing any muscle tightness or imbalance and retraining in the causative sporting activity is necessary.

Comments:
There are no major blood vessels or nerves in the area of the bursae so the injection is safe. Feeling for a loss of resistance beneath and within the glutei guides the clinician in depositing the fluid. Pain referring from the lumbar spine or sacroiliac joint can often be mistaken for gluteal bursitis. The mere presence of tenderness mid-buttock, normal in most individuals, should not be considered diagnostic of an inflamed bursa.

Alternative approaches:
For large individuals, a longer spinal needle might be required.