Trochanteric Bursa Injection

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Diagnostic Indications

  • To perform a therapeutic trial to differentiate between various causes of a condition
  • To differentiate an intra-articular from an extra-articular cause of pain symptoms

Therapeutic Indications

  • To inject lidocaine (with or without steroids) to reduce pain and/or inflammation
  • Cellulitis or broken skin over the intended entry site for injection
  • Anticoagulant therapy that is not well controlled
  • Severe primary coagulopathy
  • Infected effusion of a bursa
  • Lack of response to two or three previous injections (relative)
  • Pregnancy (relative)
  • Gloves (sterile or nonsterile)
  • Sterile drapes (optional)
  • Povidone-iodine wipes or alcohol wipes
  • 1½- to 2-inch, 22-gauge needle and 10- to 15-mL syringe
  • ½-inch, 30-gauge needle if skin anesthesia is to be given (usually not needed)
  • Single-dose vials of 1% lidocaine
  • Corticosteroid preparation
    • For injection of the trochanteric bursa, use 5 to 10 mL of 1% lidocaine and 20 to 40 mg of methylprednisolone acetate or equivalent (relative potencies and common doses).
  • Adhesive bandage dressing
  • The large trochanteric bursa lies between the tendon of the gluteus maximus and the greater trochanter.

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  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
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  • Leave an adhesive bandage dressing or other dressing on for 8 to 12 hours.
  • Advise the patient to rest the affected area. Physical therapy, NSAIDs, and hot or cold compresses all may be indicated.
  • Advise the patient to report immediately any fever, chills, or signs of infection.
  • The patient may bathe normally.
  • A short course of an NSAID often is beneficial at the time of injection.
  • Bleeding
  • Injection into a vein or artery
  • Introduction of infection (usually Staphylococcus)
  • Injury to nearby nerves
  • Subcutaneous fatty atrophy
  • Adverse drug reaction (complications)
  • Inappropriate diagnosis
  • Tendon rupture
  • Reactions to lidocaine
  • Steroid flare
  • Muscle or tendon weakness.
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