Intended for healthcare professionals

Rapid response to:


Comparison of fluoroscopically guided and blind corticosteroid injections for greater trochanteric pain syndrome: multicentre randomised controlled trial

BMJ 2009; 338 doi: (Published 14 April 2009) Cite this as: BMJ 2009;338:b1088

Rapid Response:


The use of epitrochanteric injection of corticosteroid is indeed so
simple and safe that the use of an endoscope to visually place the
injectable is useless and wasteful. There are some "tricks" and pointers
to be made to the adapter of this highly useful procedure, which can be
learned in minutes with simple study of anatomy charts and without direct
observation of the technique by someone else before first performance.

This treatment is so helpful to the grateful patients (almost
exclusively women past 40 years of age) that it should be performed on the
site by general practioners when it is first recognized on examination.
I would agree with a previous commentator that the study
using the endoscope is so flawed that it should be called overkill.

The use of a spinal length needle is helpful in obese persons. The
area of greatest tenderness must be carefully evaluated. The needle is
first directed toward the most tender point and carried to the point of
resistance to further advance. Injection of about 1/2 of the material to
be given is used here, then the neddle withdrawn 1-2 cm and re-directed to
a point about 1 cm to one side of the original injection. This area
receives 1/4 of the remaining injectable. It is repeated by re-directing
to each quadrant around the central injection site and dividing the
remainder of the injectable in the similar sites.

As to preparation, that may be open but I have found triamcinalone
either 40 or 80 mg per ml to be easiest.
1 ml of this may be premixed with lidocaine 1ml of 1% sterile solution in
the syringe. The entire amount is used for one entire treatment.

Repeat treatment in 1-2 weeks may be given but is very seldom needed.
Many with this problem may, however, return in 1-5 years for a repeat
evaluation and treatment.

Competing interests:
None declared

Competing interests: No competing interests

28 July 2009
Ralph D. Lausa
Physician, M. D.