What should I do about severe hip pain after a hip bursa (injection of corticosteroid into the bursa surrounding the hip joint) injection that has worsened over the weekend?

Managing Severe Hip Pain After Bursa Injection

If you're experiencing severe worsening hip pain after a recent hip bursa injection, you should seek immediate medical attention to rule out infection or other complications. 1, 2

Immediate Assessment and Management

• Call your healthcare provider immediately if pain is significantly worse than before the injection
• Warning signs requiring urgent evaluation:
  • Fever
  • Redness or warmth around injection site
  • Severe pain that prevents weight-bearing
  • Drainage from injection site

Understanding Post-Injection Pain Patterns

Hip bursa injections can cause several pain patterns:

1. Initial pain flare (steroid flare):

   • Temporary increase in pain 24-48 hours after injection
   • Usually resolves within 2-3 days
   • Can be managed with ice and acetaminophen

2. Failed therapeutic response:

   • Pain returns to baseline or worsens after initial improvement
   • May indicate incorrect diagnosis or need for different treatment

3. Complications:

   • Infection (rare but serious)
   • Bleeding into the bursa
   • Steroid-induced tissue damage

Treatment Recommendations

Immediate Pain Relief

• Apply ice to the injection site for 15-20 minutes every 2-3 hours
• Take acetaminophen when not contraindicated for pain relief 1
• Avoid NSAIDs for 48-72 hours after injection to prevent interference with steroid effect
• Rest and avoid activities that aggravate symptoms for 2-3 days

If Pain Persists Beyond 3-4 Days

• Contact your healthcare provider for reassessment
• Consider alternative treatments:
  • Physical therapy (high-quality evidence, moderate recommendation) 1
  • NSAIDs (high-quality evidence, strong recommendation when not contraindicated) 1
  • Alternative injection approaches or dry needling 3, 4

Follow-up Recommendations

• Schedule follow-up with your provider within 1-2 weeks if pain doesn't improve
• Imaging may be needed if symptoms persist:
  • MRI without contrast is recommended for evaluating persistent hip pain (rated 9/9) 2
  • Ultrasound may be useful for reassessing extra-articular soft tissue abnormalities (rated 7/9) 2

Important Considerations

• Hip injections require image guidance for safety and accuracy 1
• Severe pain after injection that worsens rather than improves could indicate:
  • Infection (rare but serious)
  • Incorrect needle placement
  • Underlying condition not responsive to corticosteroid
  • Need for different treatment approach

Remember that while corticosteroid injections can provide significant relief for many patients with hip bursitis 5, 6, not all patients respond favorably, and some may experience temporary worsening before improvement 7. If your pain continues to be severe or is accompanied by other concerning symptoms, prompt medical evaluation is essential.