Ultrasound-Guided Cortisone Injections for Greater Trochanteric Pain Syndrome

 

Ultrasound-Guided Cortisone Injections for Greater Trochanteric Pain Syndrome

Introduction

Greater Trochanteric Pain Syndrome (GTPS) is a common cause of lateral hip pain, often affecting individuals who engage in repetitive hip movements or prolonged standing. This condition is frequently associated with inflammation or degeneration of the gluteal tendons and trochanteric bursa, leading to persistent discomfort during walking, lying on the affected side, or climbing stairs.

Although conservative management such as physiotherapy and activity modification is the first line of treatment, persistent cases may require additional intervention. Ultrasound-guided cortisone injections can be used to help manage inflammation and pain in individuals with GTPS.

This blog provides a detailed overview of Greater Trochanteric Pain Syndrome, including its anatomy, pathology, symptoms, diagnosis, and treatment options, with a focus on the role of cortisone injections in symptom relief.




Anatomy of the Greater Trochanter and Surrounding Structures

The greater trochanter is a bony prominence on the lateral aspect of the femur and serves as the attachment site for several important hip muscles and tendons. The gluteal tendons and trochanteric bursa play a key role in the stability and movement of the hip joint.

Key Anatomical Structures Involved in GTPS

  • Greater Trochanter: The bony prominence on the lateral femur where the gluteal tendons attach.
  • Gluteus Medius and Gluteus Minimus Tendons: These muscles control hip stability and movement, inserting onto the greater trochanter.
  • Trochanteric Bursa: A fluid-filled sac that cushions the greater trochanter and surrounding tendons, reducing friction during movement.
  • Iliotibial Band (ITB): A fibrous structure running along the outer thigh, contributing to hip stability.

When these structures become inflamed, irritated, or degenerated, Greater Trochanteric Pain Syndrome may develop.

Pathology of Greater Trochanteric Pain Syndrome

GTPS is a multifactorial condition that involves tendinopathy, bursitis, or both.

Gluteal Tendinopathy

  • The gluteus medius and minimus tendons may undergo degenerative changes due to repetitive stress, leading to microtears and tendon weakening.
  • Poor biomechanics, muscle imbalances, or overuse can contribute to this tendon degeneration.
  • Chronic tendinopathy may lead to partial or complete tendon tears, further exacerbating pain and functional limitations.

Trochanteric Bursitis

  • The trochanteric bursa can become inflamed due to excessive friction between the gluteal tendons and the greater trochanter.
  • Inflammation of the bursa can cause swelling and irritation, leading to localised pain over the lateral hip.
  • Bursitis often occurs secondary to gluteal tendinopathy or repetitive hip movements.

Symptoms of Greater Trochanteric Pain Syndrome

  • Pain over the lateral hip, which may radiate down the outer thigh.
  • Discomfort when lying on the affected side, particularly at night.
  • Pain during walking, climbing stairs, or prolonged standing.
  • Weakness in hip abduction, leading to an altered gait.
  • Tenderness over the greater trochanter upon palpation.

Symptoms often worsen with activity and may become chronic if left untreated.

Diagnosis of Greater Trochanteric Pain Syndrome

Clinical Examination

A clinician will assess the hip through:

  • Palpation of the greater trochanter, identifying local tenderness.
  • Resisted hip abduction tests, checking for gluteal tendon weakness or pain.
  • The FABER Test (Flexion, Abduction, and External Rotation): Identifies hip and trochanteric pain.

Imaging Studies

  • Ultrasound: Can detect tendon thickening, partial tears, and bursal inflammation.

Management of Greater Trochanteric Pain Syndrome

Conservative Treatment

  • Activity Modification: Avoiding excessive hip abduction or prolonged standing.

When symptoms do not improve with conservative treatment, ultrasound-guided cortisone injections may be considered.

Ultrasound-Guided Cortisone Injections for Greater Trochanteric Pain Syndrome

What Are Cortisone Injections?

Cortisone is a potent anti-inflammatory steroid used to reduce inflammation in the bursa or gluteal tendons.

Why Use Ultrasound Guidance?

  • Ensures precise delivery of the injection into the affected bursa or tendon sheath.
  • Reduces the risk of injecting nearby structures.
  • Improves treatment accuracy and effectiveness.

Procedure

  1. The clinician applies ultrasound imaging to locate the affected tendon or bursa.
  2. The skin is cleaned, and a local anaesthetic is applied.
  3. A fine needle is inserted under ultrasound guidance into the inflamed bursa or tendon region.
  4. A mixture of cortisone and local anaesthetic is injected.

Patients are typically advised to rest the hip for a short period post-injection and gradually resume activities.

Mechanism of Action of Cortisone Injections

Cortisone works by:

  • Reducing inflammation in the trochanteric bursa and surrounding tendons.
  • Inhibiting immune responses that contribute to swelling and pain.
  • Stabilising cell membranes to prevent further inflammatory damage.

This leads to temporary pain relief, allowing individuals to participate in rehabilitation and strengthening exercises.

Benefits of Cortisone Injections for Greater Trochanteric Pain Syndrome

  • Provides targeted pain relief for lateral hip pain.
  • Minimally invasive treatment with minimal downtime.
  • Improves mobility and function in individuals with persistent symptoms.

Although cortisone injections do not cure GTPS, they can be part of a comprehensive management approach to reduce inflammation and facilitate recovery.

Conclusion

Greater Trochanteric Pain Syndrome can cause persistent hip pain that affects mobility and quality of life. While conservative management is often effective, ultrasound-guided cortisone injections may be considered for individuals with persistent symptoms.

At Alton Pain Clinic, clinicians provide precise, ultrasound-guided injections to help manage pain and support rehabilitation for GTPS. If you are experiencing persistent lateral hip pain, a consultation may help determine the most suitable treatment approach.

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