The Evidence Behind Corticosteroid Injections for Hip and Knee Pain Greater trochanteric pain syndrome , commonly known as greater trochanteric bursitis, is common among the general population, affecting 8.5 % of women...
The Evidence Behind Corticosteroid Injections for Hip and Knee Pain Greater trochanteric pain syndrome , commonly known as greater trochanteric bursitis, is common among the general population, affecting 8.5 % of women and 6.6 % of men in a large observational study 1 and hip pain affects more than 14 percent of the population in another 2 . The greater trochanter is associated with bursae that provide protection for the surrounding tendons, namely, the gluteus medius and minimus, ITB, and tensor fascia lata. The most superior bursa, the subgluteus medius bursa, sits superior to the greater trochanter under the gluteus medius tendon.
The subgluteus maximus bursa sits between the tendons of the gluteus medius and maximus and lateral to the greater trochanter. The deep subgluteus maximus bursa is a division sometimes referred to as the trochanteric bursa 3 . Patients with greater trochanter pain syndrome will commonly complain of lateral hip pain that is worse with pressure, such as while lying down on the affected side.
They often complain of pain with walking and may admit that pain is worse while standing on the affected leg. There may be associated lateral thigh pain radiation but rarely below the knee 3 , 4 . Illustration of greater trochanteric bursa corticosteroid injection (courtesy of AAOS) Local injections in the lateral hip region were shown to be favorable and have long term benefit up to 2 years in multiple studies in the starting in the 1960s until the 1980s 5 , 6 , 7 .
The longevity of these injections has come into question over the past two decades, however. It has been shown that corticosteroid injections were superior to physical therapy treatment alone at 3 months (55% fully recovered vs. 34% recovered), but the effect was not evident at 12 months 8 .
Another study showed pain relief that was greatest at one week but still effective in 61 percent of patients at 26 weeks 9 . One other randomized trial with more than 200 patients concluded that corticosteroid injection was superior to home therapy and shock wave therapy at 1 month, but corticosteroid injections had worse outcomes compared to shock wave therapy at fifteen months 10 .More recent studies have shown ultrasound guided injections into the subgluteus maximus bursa provide more pain relief compared to injections into the subgluteus medius bursa 11 . Another trial showed 72 % of patients with significant improvement at 3 months following an ultrasound guided injection 13 .
If you are experiencing symptoms that may be related to evidence behind corticosteroid injections of the hip and knee, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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