Ultrasound guided injection of the greater trochanter allows careful deposition of steroid or adjunct into the superficial greater trochanteric bursa in patients with localized hip pain. Visualize the bony cortex of the greater trochanter and insert needle under usual sterile technique until enter the bursa if it is fluid filled or you hit the cortex of underlying bone.
so our patient has been diagnosed with rare trochanteric bursitis the bursa is a fluid-filled cavity where there is the insertion points of the gluteal tendons and the external hip rotators onto the femur bone it's tender in this spot on the trochanter and we're going to do an injection under ultrasound guidance as you see here i found the trochanter it's the hyperlucency at the bottom and the striations above it can be the insertion points of the gluteal tendons i'm going to clean the patient i'm going to spray her to anesthetize the skin a little pinch and the needle is very thin but you can visualize it here i'm going to increase my depth there's the bone i'm now going to visualize the needle on the bone again and inject the steroid there we go there we see the needle going to the trochanter and injecting you see the black spread around yep that's by the tendon to the gluteal muscles and the blackness spreading around the bone is the local anesthetic we're done basically we injected her with a mixture of 20 milligrams depth of metro and 30 ml of lupicaine to alleviate the bursitis and the inflammation this should give her some relief and she should avoid lying on this side at night
