title: Corticosteroid injections for trochanteric bursitis: is fluoroscopy necessary? A pilot study.
abstract: BACKGROUND
  Numerous studies have demonstrated that therapeutic injections carried out to treat a variety of different pain conditions should ideally be performed under radiological guidance because of the propensity for blinded injections to be inaccurate. Although trochanteric bursa injections are commonly performed to treat hip pain, they have never been described using fluoroscopy.
  
  
  METHODS
  The authors reviewed recorded data on 40 patients who underwent trochanteric bursa injections for hip pain with or without low back pain. The initial needle placement was done blindly, with all subsequent attempts done using fluoroscopic guidance. After bone contact, imaging was used to determine if the needle was positioned on the lateral edge of the greater trochanter (GT). Once this occurred, 1 ml of radiopaque contrast was injected to assess bursa spread.
  
  
  RESULTS
  The GT was contacted in 78% of cases and a bursagram obtained in 45% of patients on the first needle placement. In 23% of patients a bursagram was obtained on the second attempt and in another 23% on the third attempt. Four patients (10%) required four or more needle placements before a bursagram was appreciated. Attending physicians obtained a bursagram on the first attempt 53% of the time vs 46% for fellows and 36% for residents (P=0.64). Older patients were more likely to require multiple injections than younger patients.
  
  
  CONCLUSIONS
  Radiological confirmation of bursal spread is necessary to ensure that the injectate reaches the area of pathology during trochanteric bursa injections.
authors.affiliation: Pain Management Center, Department of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. spc5_2000@yahoo.com
authors.forename: S P
authors.initials: SP
authors.lastname: Cohen
authors.forename: J C
authors.initials: JC
authors.lastname: Narvaez
authors.forename: A H
authors.initials: AH
authors.lastname: Lebovits
authors.forename: M P
authors.initials: MP
authors.lastname: Stojanovic
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D002062:Bursitis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002983:Clinical Competence; D005260:Female; D005471:Fluoroscopy; D006621:Hip Joint; D006801:Humans; D015552:Injections, Intralesional / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010147:Pain Measurement; D010865:Pilot Projects
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents