A greater trochanteric bursa injection targets the fluid-filled sac (bursa) located on the lateral aspect of the hip, over the greater trochanter — the bony prominence at the top of the femur. This bursa cushions the gluteal tendons and the iliotibial (IT) band as they pass over the greater trochanter, and when it becomes inflamed, patients experience pain on the outside of the hip that can radiate down the lateral thigh and significantly impair mobility and sleep quality.
Trochanteric bursitis is one of the most common causes of lateral hip pain encountered in clinical practice. It occurs when the bursa becomes irritated due to repetitive friction from the IT band, direct pressure from lying on the affected side, gait abnormalities, hip muscle weakness, or overuse. The condition is exacerbated by activities such as walking, climbing stairs, running, and lying on the affected hip. It frequently coexists with gluteal tendinopathy and lumbar spine pathology, requiring a careful diagnostic evaluation to identify all contributing pain generators.
At Interventional Pain Consultants, trochanteric bursa injections are performed under ultrasound guidance to ensure precise delivery of medication into the bursal space. Ultrasound allows the physician to visualize the inflamed bursa, the overlying IT band, and the adjacent gluteal tendons, ensuring that the injectate is placed exactly where it is needed while avoiding unintentional injection into the tendons or surrounding soft tissues.
With the patient positioned lying on the unaffected side (lateral decubitus), the physician uses ultrasound imaging to identify the greater trochanter, the trochanteric bursa (which may be distended with fluid when inflamed), and the overlying gluteal tendons and IT band. The skin is cleansed with antiseptic solution, and a small amount of local anesthetic is administered to numb the skin and subcutaneous tissues.
Under real-time ultrasound guidance, a fine-gauge needle is advanced into the bursal space between the greater trochanter and the IT band. The physician may aspirate any fluid collection (bursal effusion) for diagnostic purposes before injecting the therapeutic medication. The injectate typically contains a local anesthetic (lidocaine or bupivacaine) for immediate pain relief and diagnostic confirmation, and a corticosteroid (triamcinolone or methylprednisolone) to suppress the inflammatory response within the bursa.
The injection procedure is quick, typically requiring 5-10 minutes to complete. Patients are positioned comfortably on their side, and the physician identifies the injection site using ultrasound imaging. Most patients experience minimal discomfort during the procedure, with the local anesthetic providing effective pain control for the injection itself.
Immediately following the injection, the local anesthetic provides rapid pain relief that confirms accurate placement and provides diagnostic information. Patients frequently report that they can walk more comfortably and that the characteristic lateral hip pain is significantly reduced or eliminated. The anesthetic effect lasts 4-8 hours, and patients are advised to rest the hip during this period and avoid overactivity that could mask the protective sensation of pain.
After the anesthetic wears off, patients may experience mild soreness at the injection site for 24-48 hours. Ice application and over-the-counter analgesics can be used as needed for comfort. The corticosteroid reaches peak effect within 3-7 days, at which point patients typically notice substantial improvement in their lateral hip pain, particularly with walking, climbing stairs, and lying on the affected side.
Patients are encouraged to begin gentle hip stretching and strengthening exercises 2-3 days after the injection, under the guidance of a physical therapist. Addressing the underlying biomechanical factors that contributed to the development of trochanteric bursitis — such as hip abductor weakness, gait abnormalities, IT band tightness, and core instability — is essential for preventing recurrence and achieving durable long-term relief.
Trochanteric bursa injections are indicated for patients with lateral hip pain and tenderness over the greater trochanter who have not adequately responded to conservative measures such as activity modification, ice, and physical therapy. The procedure is contraindicated in patients with active infection over the injection site, coagulopathy, or known allergy to any components of the injectate. It is important to distinguish trochanteric bursitis from other causes of lateral hip pain, including gluteal tendinopathy, hip joint pathology, lumbar radiculopathy, and sacroiliac joint dysfunction.
At Interventional Pain Consultants, we perform a comprehensive evaluation of patients presenting with lateral hip pain, including a thorough history, physical examination, and review of imaging studies. We utilize ultrasound-guided trochanteric bursa injections as part of a multidisciplinary treatment approach that addresses not only the symptomatic bursitis but also the underlying biomechanical factors and associated conditions that contribute to the patient's pain.
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