Ultrasound-guided steroid injections for hip bursitis
Hip bursitis is common, as a few bursae are present around the hip joint. The article describes the role of ultrasound-guided steroid injections in managing bursitis around the hip joint.
What is a bursa?
A bursa is a thin fluid-containing sac usually seen between a tendon and a bony prominence within the body to provide protection and cushioning effect. We have of these around the hip.
What is bursitis?
Bursitis refers to inflammation of a bursa, and "tendonitis" refers to inflammation of the adjacent tendon. The trochanteric bursa is the main bursa in the hip area. It is located outside the hip, next to a bony prominence (called the greater trochanter).
What are the different bursae found around the hip?
There are mainly 3 bursae around the hip
What is trochanteric bursitis?
This is one of the common indications for ultrasound-guided steroid injections in our practice. In this condition, there is pain outside the hip due to inflammation of the trochanteric bursa. "The trochanteric bursa" is found outside the hip, next to a bony prominence (called the greater trochanter), hence the condition's name. It is often associated with irritation of the tendons attaching to the greater trochanter (called the gluteal tendons); therefore, this condition is sometimes referred to as “gluteal tendonitis”. Trochanteric pain syndrome is an umbrella term for the different conditions that could affect this area. Please read our article about Trochanteric pain syndrome to find out more.
What is iliopsoas bursitis?
The iliopsoas tendon runs at the front of the hip joint, and the muscle plays a primary role in hip flexion (bringing your knee towards your chest). Iliopsoas tendonitis/tendinopathy refers to inflammation and irritation of the tendon. This tends to be an overuse injury when there is repetitive hip flexion (for example, in running and cycling). It can also be seen in patients with hip replacement. The condition can be associated with fluid accumulation between the tendon and the hip bone within a small sac "called the psoas bursa". The condition is referred to as “iliopsoas bursitis”. It can be associated with hip osteoarthritis as the hip joint communicates with the iliopsoas bursa in about 15% of cases. Therefore excess fluid within the hip joint that results from hip arthritis can distend the iliopsoas bursa. To learn more, please read our article about iliopsoas bursitis/tendinosis.
What is ischiogluteal bursitis?
Ischiogluteal bursitis refers to the build-up of excess fluid within a small sac (bursa) on top of the ischial tuberosity (the sit bone) and the proximal hamstring tendon in the buttock area. It is often associated with inflammation of the proximal hamstring tendon, "referred to as tendinopathy". Please read our article about Proximal Hamstrings tendinosis/tear to find out more.
What is a hip bursa cortisone injection?
Corticosteroid (cortisone) is a potent anti-inflammatory medicine routinely used to manage inflammatory conditions (like bursitis, arthritis and tendinosis). A cortisone injection will reduce the inflammation in the injected area (like the hip joint or trochanteric bursa) and allow you to manage the condition, usually by undergoing an effective physiotherapy program.
Should hip injections be done under ultrasound guidance?
Yes. This is our routine practice, as plenty of evidence supports ultrasound guidance when performing joint injections. Doing hip injections under ultrasound/imaging guidance allows for direct visualisation of the needle to ensure accurate placement into the area of pain/inflammation (like a bursa, an arthritic joint or an inflamed tendon sheath). Ultrasound guidance results in more accurate, less painful and faster procedures, with better outcomes than these injections without guidance. Ultrasound guidance avoids sensitive structures (like nerves and vessels) during the procedure.
In trochanteric bursa injections, ultrasound guidance ensures injecting the medicine accurately. Inadvertent administration of the steroid into the adjacent gluteal tendons can cause tendon weakening and thus should be avoided. An initial ultrasound assessment is very important for the same reason, as it will rule out the presence of a significant tendon tear.
Do I need a hip cortisone injection?
Generally, the management of most hip conditions starts with physiotherapy treatment and progressive rehabilitation. The duration of this depends on the condition. If the response from the above is poor or not satisfactory, then an ultrasound-guided hip treatment option may be considered. Injection therapy can be very useful in reducing pain and improving function, allowing for more effective rehabilitation. We always advise performing hip injections under ultrasound guidance by an experienced doctor to ensure accurate medicine delivery to the targeted area.
Are hip bursa cortisone injections safe?
These injections are generally very safe and routinely done in our practice. There is a very small risk of infection (about 1:10.000). There is a possibility that the injected area will feel sore for the first few days. This is referred to as (steroid flare) and can be seen after a steroid injection. The procedure will be explained in detail during your appointment, and all your questions will be addressed. To find out more about cortisone injection in general, please see our FAQs.
For more information about hip steroid injections, please see our article about ultrasound-guided steroid injections around the hip.
Hip conditions and treatments
