Skip to main content

Elusive trochanteric bursitis relief

An interesting observation draws attention to technique issues. Nissen et al. [1] found that intra-trochanteric injection with betamethasone produced no greater long-term benefit than saline injections for greater trochanteric pain syndrome. One, three, and six month post-injection pain intensity was unaffected by this intervention. Their recommendation that future patients be advised of unlikely long-term benefit would seem reasonable, except for two fundamental methodologic flaws precluding such clinical application of their findings. Betamethasone is water soluble [2] and the terminology trochanteric bursa may be misleading. There are actually four bursa surrounding attachments to the femoral greater trochanter [3]. Those have been variously reported to include the gluteus medius, gluteus minimus, subgluteus medius, and subgluteus minimus tendons [3, 4].

There does not appear to be evidence that involvement in individuals with the greater trochanteric pain syndrome is limited to a single bursa. My personal approach is to inject all four of the above-delineated bursa, as I, too, found that injection of a single bursa did not provide long-term relief. The injection procedure is to note presence of pain on positioning the needle in each bursa, prior to the injection of each. That not only confirms the appropriate site for injection but also notes that bursa is inflamed. My observation is that all four bursa are inflamed, or at least sources of clinical symptoms, in almost all individuals with greater trochanteric pain syndrome.

Returning the first point, it is unclear that water-soluble, highly diffusible agents remain in sufficient quantity (levels) in the injected areas to provide long-term relief or even to allow healing of the inflammatory process. This concern for bursal injections is predicated upon noted lack of efficacy of most water soluble, contrasted with water-insoluble corticosteroids efficacy for knee joint injections [5]. It should be noted that joint (as opposed to bursa) steroid injections are no longer favored because of the damage to joint cartilage [6], not an issue in bursal closed spaces. My choice of injectable is the water-insoluble/depot drug, triamcinolone, assuring that all inflamed bursa are injected.


  1. 1.

    Nissen MJ, Brulhart L, Faundez A, Finckh A, Couvoisier DS, Genevay S (2019) Glucocorticoid injections for greater trochanteric pain syndrome: a randomized double-blind placebo-controlled (GLUTEAL) trial. Clin Rheumatol 38:647–655

    Article  PubMed  Google Scholar 

  2. 2.

    MacMahon PJ, Eustace SJ, Kavanagh EC (2009) Injectable corticosteroid and local anesthetic preparations. Radiology 252:647–661

    Article  PubMed  Google Scholar 

  3. 3.

    Williams BS, Cohen SF (2009) Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg 108:1662–1670

    Article  PubMed  Google Scholar 

  4. 4.

    Dunn T, Heller CA, McCarthy SW, Dos Remedios C (2003) Anatomical study of the “trochanteric bursae”. Clin Anat 16:233–240

    Article  PubMed  Google Scholar 

  5. 5.

    Cole BJ, Schumacher HR Jr (2005) Injectable corticosteroids in modern practice. J Am Acad Orthop Surg 13:37–46

    Article  PubMed  Google Scholar 

  6. 6.

    McAlindon T, LaValley M, Harvey W, Price LL, Driban JB, Zhang M, Ward RJ (2017) Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA 317:1967–1975

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Bruce Rothschild.

Ethics declarations



Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rothschild, B. Elusive trochanteric bursitis relief. Clin Rheumatol 38, 1793 (2019).

Download citation