Arthrocentesis & Injections: Hip and Trochanteric Bursal
Last updated: October 15, 2014
Patient Position: The patient should lie on his or her side, with the painful trochanter (“hip”) facing up.
Limb Position: The legs should be comfortably extended, side by side.
Bony Landmarks: Usually the greater trochanter is the most elevated point over the hip curvature. Using one finger, identify the point of maximal tenderness over the bony greater trochanter.
Entry Angle: A 19-23 gauge needle should be used to introduce anesthetic first, followed by corticosteroid injection. The needle should be directed downward at a 90-degree angle and slowly advanced to anesthetize the subcutaneous tissues in stages until the needle tip pierces the painful bursa or touches the greater trochanter. Before injecting steroid, you will likely instill 2-4 mL of 1% lidocaine as you fully advance the 1.5 inch needle. Aspirate before injecting.
Amount of Injection: Use 40 to 60 mg Depo-Medrol (or equivalent) and 0.5 mL of 1% lidocaine in a total volume of 0.5 to 3 mL.
Comment: When entering an inflamed bursa, the operator may feel a “pop” or the patient may note a sudden sharp pain. Rarely is there sufficient bursal fluid to aspirate.