Recommended Steroid Dose for Greater Trochanteric Bursitis Injection of the Hip
For greater trochanteric bursitis injection of the hip, a combination of corticosteroid with lidocaine is recommended, typically using 40-80 mg of methylprednisolone or equivalent corticosteroid mixed with 2-3 mL of 1-2% lidocaine. 1
Injection Components and Technique
Recommended Injection Mixture:
- Corticosteroid: 40-80 mg methylprednisolone acetate (or equivalent)
- Local anesthetic: 2-3 mL of 1-2% lidocaine
- Total volume: Approximately 3-5 mL
Injection Guidance:
- Ultrasound guidance is preferred for accurate needle placement 1, 2
- Target the greater trochanteric bursa specifically rather than the subgluteus medius bursa for better pain relief 2
- Fluoroscopic guidance may be considered for patients with high BMI 3
Efficacy and Outcomes
Research demonstrates that properly placed corticosteroid injections can provide significant pain relief for patients with greater trochanteric pain syndrome:
- Injections into the greater trochanteric bursa show better pain reduction (median pain reduction of 3 points on a 10-point scale) compared to subgluteus medius bursa injections (median pain reduction of 0) 2
- Local corticosteroid therapy followed by physical therapy is effective in approximately 49% of patients, while corticosteroid injection alone is effective in about 39% of patients 4
Treatment Algorithm
- First-line treatment: NSAID therapy and physical therapy
- If symptoms persist: Consider corticosteroid injection
Important Considerations
- Ultrasound can reliably detect trochanteric bursitis but may have difficulty differentiating between bursitis and gluteus medius tendinosis, which often coexist 1
- When using fluoroscopic guidance, injections into the trochanteric bursa may maintain pain reduction better at 1-week post-injection compared to subgluteus medius bursa or non-bursal injections 3
- Dry needling has been shown to be non-inferior to corticosteroid injections for pain relief and functional improvement in greater trochanteric pain syndrome, offering an alternative treatment option 5
Potential Pitfalls
- Misplacement of injection: Ensure proper needle placement into the greater trochanteric bursa rather than surrounding tissues for optimal results
- Inadequate dose: Using insufficient corticosteroid may result in suboptimal pain relief
- Failure to identify coexisting pathologies: Gluteus medius/minimus tendinopathy often coexists with trochanteric bursitis and may require additional treatment approaches
- Extracapsular disease associated with adverse reactions to metal debris (ARMD) could be misinterpreted as trochanteric bursitis in patients with hip arthroplasty 1
For optimal outcomes in treating greater trochanteric bursitis, use image guidance (preferably ultrasound) to ensure accurate placement of the corticosteroid-lidocaine mixture into the greater trochanteric bursa specifically.