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Subject: Greater Trochanteric Bursa Injection
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Syringe, 10 mL.
gauge, 1.5 inches) on a 10-mL syringe (consider a longer needle
for the obese patient).
Methylprednisolone acetate (40 mg
Depo-Medrol; 1 mL if 40 mg/mL). One mL of 40 mg/mL triamcinolone
acetonide (Kenalog) is a reasonable
alternative to Depo-Medrol but may carry a higher risk of
atrophy than Depo-Medrol.
1% lidocaine (5 mL) without epinephrine.
Consult the ordering
information that appears in Appendix I. Needles,
syringes, and corticosteroid preparations may be ordered from
surgical supply houses or local pharmacies. A suggested tray for
performing soft tissue aspirations and injections is listed in Appendix
I. Skin preparation recommendations appear in Appendix
at the greater trochanter of the hip
Drug allergy to
arthritis, bacteremia, or cellulitis at the injection site
Minimal relief after
prior injections (relative)
or uncontrolled anticoagulation (relative)
(scarring changes anatomy; foreign body increases risk for
infectious complications) (relative)
PEARL: Maximal tenderness is often found
at the muscle insertions along the superior and posterior
borders of the greater trochanter. This may require larger
injection volumes and/or a fanned technique to disperse the
medication to the deep bursae, which superficially blankets
the tendons described previously.
PITFALL: Long-acting, low-solubility,
fluorinated glucocorticoids (such as triamcinolone
hexacetonide [Aristospan]) are
considered inappropriate for soft tissue injections by some
authors because of a higher risk of tissue atrophy. Triamcinolone
acetonide (Kenalog) is a fluorinated triamcinolone, but solubility is
intermediate to high. This makes Kenalog a reasonable
alternative for this procedure but it may carry a higher
risk of tissue atrophy than methylprednisolone.
infection (reported incidence range 1:3,000 to
reactions (swelling, tenderness, and warmth for up to 2
(1% to 10%; crystal-induced synovitis within
24 to 48 hours).
(especially at superficial soft tissue sites; worse with triamcinolone because it is less
soluble and is fluorinated).
local cartilage or nerves.
flushing (<15% of patients; within hours;
lasts <3 or 4 days; women)
suppression (usually mild and transient; worse with
increase in glucose