Trochanteric Bursa Injection

Acute or chronic bursitis

Causes and findings:
• Usually a direct blow or fall onto hip
• Occasionally overuse or, in the thin elderly patient, lying on the same side every night, usually on a hard mattress
• Pain and tenderness over greater trochanter
• Painful: passive abduction, adduction and possibly flexion and extension of the hip resisted abduction

Equipment:
Syringe - 2ml
Needle - 23G 1.25 inches (30mm) blue
Kenalog 40 - 20 mg
Lidocaine - 1.5 ml 2%
Total volume - 2 ml

Anatomy:
The trochanteric bursa lies over the greater trochanter of the femur. It is approximately the size of a golf ball and is usually tender to palpation.

Technique:
• Patient lies on unaffected side with lower leg flexed and upper leg extended
• Identify and mark tender area over greater trochanter
• Insert needle perpendicularly at centre of tender area and touch bone of greater trochanter
• Inject by feeling for area of lack of resistance and introduce fluid there as a bolus

Aftercare:
Patient should avoid overuse for 1 week and then gradually return to normal activity. If the cause is lying on a hard mattress, the trochanter can be padded with a large circle of sticky felt. A change of lying position is encouraged and the mattress might need to be changed. Stretching of the iliotibial band can also help.

Comments:
A fall or direct blow onto the trochanter will often cause a haemorrhagic
bursitis. This calls for immediate aspiration of blood prior to the infiltration.