When cortisone is injected into both hips for bursitis, is it administered into the joint space or directly into the bursa?

Hip Bursitis Injections: Target Site

For hip bursitis, cortisone is injected directly into the bursa, not into the hip joint space. 1

Anatomical Distinction and Injection Targets

The hip region contains multiple bursae that can become inflamed, with the trochanteric bursa being the most common site of hip bursitis. The injection target depends on the specific diagnosis:

Trochanteric Bursitis

• The corticosteroid is injected into the trochanteric bursa, which lies over the greater trochanter of the femur 1
• This is an extra-articular structure, completely separate from the hip joint space 1
• Ultrasound guidance is recommended to ensure accurate bursal placement and reduce procedural pain 2

Iliopsoas Bursitis

• Injections target the iliopsoas bursa, located anterior to the hip joint 3
• Five out of six studies specifically used the iliopsoas bursa as the injection target, not the joint 3
• This bursa can communicate with the hip joint in some individuals, but the injection is still directed at the bursal space 1

Diagnostic Differentiation

The ACR guidelines emphasize that injection location serves as a diagnostic tool to identify the pain source 1:

• Trochanteric bursa injection relieving pain confirms trochanteric bursitis as the source 1
• Intra-articular hip joint injection relieving pain suggests the pain originates from within the joint itself 1
• Iliopsoas bursa or peritendinous injection can distinguish iliopsoas-related pain 1

Common Pitfall to Avoid

Do not confuse hip bursitis treatment with intra-articular hip joint injections. These are entirely different procedures for different conditions:

• Hip bursitis = bursal injection (extra-articular) 1
• Hip osteoarthritis or labral tears = joint space injection (intra-articular) 4, 1

The imaging guidance recommendations differ as well—ultrasound is particularly useful for visualizing superficial structures like the trochanteric bursa and guiding bursal injections 1, while fluoroscopy or ultrasound may be used for intra-articular hip joint injections 1.

Typical Injection Composition

For bursal injections, the standard formulation includes 2, 5:

• 20-40 mg of triamcinolone or methylprednisolone (most commonly used corticosteroids) 2, 5
• Mixed with lidocaine (79-87% of sports medicine physicians use this combination) 5
• Total volume of 5-7 mL for large bursa injections 5

Higher doses (>40 mg) should be avoided due to increased systemic adverse effects without additional benefit 2, 6.