Ultrasound-guided injections treatment for greater trochanteric pain syndrome
Trochanteric pain syndrome is common in up to 25% of the population. It is characterised by pain and tenderness at the outer aspect of the hip, particularly when lying on the affected side. The anatomy in this area (as well as the cause of the pain) can be complex. Therefore, ultrasound is very useful in assessing the cause of the pain and guiding any injection therapy.
Relevant anatomy
The greater trochanter is a bony prominence at the side of the hip, providing attachment to two tendons (the gluteus medius and gluteus minimus). The trochanteric bursa lies just on top of these tendons and the greater trochanter. A bursa is a thin fluid-containing sac usually seen adjacent to a bone to provide a cushioning effect and help in the smooth movement of the tendon. We have a few of these within our body (like in the shoulder and the hip).
What are the causes of greater trochanteric pain syndrome?
The most common cause of greater trochanteric pain syndrome is inflammation of the gluteal tendons at their attachment to the greater trochanter, a condition referred to as "gluteal tendinosis or tendinopathy".
Often, there is associated inflammation of the overlying trochanteric bursa. This is referred to as "trochanteric bursitis".
In more advanced cases, there could be a tear of the gluteal tendons.
Ultrasound assessment is very useful in assessing the anatomical structures in this area, including the gluteal tendons and the trochanteric bursa, to decide about the best management options. To find out more, please see our article about trochanteric bursitis.
What are the mimics of greater trochanteric pain syndrome?
Trochanteric bursitis should be differentiated from ischiogluteal bursitis. This is another type of bursitis that can cause deep pain in the buttock area adjacent to the sit bone. Please read our article to learn more about the different types of bursitis around the hip. Also, greater trochanteric pain syndrome should not be mistaken for hip osteoarthritis. This usually results in pain at the front of the hip joint. To find out more, please see our article about hip arthritis.
Is ultrasound useful in assessing greater trochanteric pain syndrome/trochanteric bursitis?
Yes. Ultrasound can assess the gluteal tendons for any tendon inflammation or tendon tear and the trochanteric bursa for any inflammatory changes. It provides an accurate and quick assessment of the condition, and it is essential to establish the correct diagnosis and guide further treatment decisions.
Performing hip bursa injections under ultrasound guidance allows for direct visualisation of the needle to ensure accurate placement into the area of pain/inflammation. Ultrasound guidance results in more accurate, less painful and faster procedures, with better outcomes than these injections without guidance.
Does ultrasound-guided cortisone injection help in managing greater trochanteric pain syndrome?
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 area/trochanteric bursa and allow you to manage the condition, usually by undergoing an effective physiotherapy program.
In greater trochanteric pain syndrome, ultrasound guidance ensures injecting the medicine accurately into the bursa. 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. To learn more, please see our article about ultrasound-guided hip cortisone injections.
What are the other available injection treatment options for greater trochanteric pain syndrome?
The other injection treatment options for greater trochanteric pain syndrome include Platelets rich plasma (PRP) injections and tendon fenestration of the gluteal tendons. In PRP injection, a small amount of blood is taken from your arm and put in a special centrifuge machine to separate its different components. The layer on top is called “the plasma”, which contains platelets and other useful growth factors. This is injected into the tendon under ultrasound guidance to help stimulate healing. Please see our PRP injections article for more details. In tendon fenestration/tenotomy, a small needle is used to fenestrate the inflamed tendon multiple times under ultrasound guidance. Evidence shows that his process results in the release of valuable factors to promote tendon healing.
Hip conditions and treatments
