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Research

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

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1088 (Published 14 April 2009) Cite this as: BMJ 2009;338:b1088

Trochanteric Bursitis: Easy Diagnosis, Easy Location for CS Injection

Trochanteric bursitis is a common cause of hip pain secondary to an
inflammation of the subgluteus maximus bursa. However, inflammatory
findings have not ever been found in tissue samples (1).
Diagnosis is easily made in clinical settings but, in some instances,
ultrasounds and MRI were found to be useful diagnostic tools (2) (3).

Steroid injection have been postulated as preferred and definitive
treatment in trochanteric bursitis (4)
Cohen and colleagues study (5) demonstrated that local steroid injection
using a fluoroscopic guide improved not outcomes as compared to blind
local steroid injection alone, increasing costs.

We also postulate that fluoroscopic guide exposes patients and heath
personnel to unnecessary radiation doses according to ALARA basis (As Low As
Reasonably Achievable) for Radiation Safety.
We support blind local steroid injection as basis for trochanteric
bursitis therapy but also emphasize the complementary role of
rehabilitation therapy (ultrasounds and stretching programs)

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refuting the myth of inflammation. J Cli Rheumatol 2008; 14 (2): 82-6

Kong A, Van der Vliet A, Zadow S. MRI and US of gluteal tendinopathy
in greater trochanteric pain syndrome. Eur Radiol 2007; 17: 1772-1783

Blakenbaker DG, Ullricik SR, Davis KW, De Smet AA, Haaland B, Fine
JP. Correlation of MRI findings with clinical findings of trochanteric
pain syndrome. Skeletal Radiol 2008; 37(10): 903-9

Stephens MB, Beutler AI, O’Connor FG. Musculoskeletal injections: a
review of the evidence. Am Fam Physician 2008; 78 (8): 971-6

Cohen SP, Strassels SA, Foster L, Marvel J, Williams K, Crooks M,
Gross A, Kurihara C, Nguyen C, Williams N. Comparison of fluoroscopically
guided and blind corticosteroid injections for greater trochanteric pain
syndrome: multicentre randomised controlled trial. BMJ 2009; 338: b1008

Competing interests:
None declared

Competing interests: No competing interests

17 April 2009
Francisco Ramirez Lafita MD, FACP
Dept of Occupational Health
A Duran MD, A Amigó MD, M Castellà MD
ANAV Dept of Health. L'Hospitalet de l'Infant 43890, Spain