Hip bursitis, known as trochanteric bursitis, is an inflammation of the bursa, a small, fluid-filled sac located on the outside of the hip joint. This bursa sits near the greater trochanter, the prominent bony point of the thigh bone. When the sac becomes irritated and swollen, it causes pain and tenderness on the outer hip, often making sleeping on that side difficult. Corticosteroid injections are a common intervention used to provide significant relief when conservative measures fail to calm this localized inflammation.
How Corticosteroids Reduce Inflammation
Corticosteroids are synthetic versions of cortisol, a hormone naturally produced by the adrenal glands. When injected directly into the inflamed bursa, these agents suppress the localized immune response causing swelling and pain. They achieve this by attaching to specific receptors inside cells and altering protein production.
The medication slows down the chemical cascade that leads to inflammation. Corticosteroids inhibit the release of pro-inflammatory substances like prostaglandins, which are responsible for pain and swelling signals. This action reduces the dilation of blood vessels and decreases the accumulation of fluid and immune cells at the injection site. By tackling the inflammation at its source, the injection reduces pressure and irritation within the bursa, alleviating the associated pain.
The Injection Process and Anticipated Results
The steroid injection is a quick, outpatient procedure designed to maximize delivery of the anti-inflammatory medication directly into the trochanteric bursa. To ensure precision, physicians often use imaging guidance, such as ultrasound or fluoroscopy (a type of X-ray). This guidance allows the provider to visualize the needle tip and confirm the medication is placed accurately into the bursa sac, improving the likelihood of a successful outcome.
The injection itself typically involves a combination of a corticosteroid and a local anesthetic, such as bupivacaine. The anesthetic offers immediate, temporary pain relief, often lasting only a few hours. The therapeutic effect of the steroid component is not instant; it usually begins to take effect two to five days following the procedure, with the greatest pain relief often reported around six weeks post-injection.
Results are highly variable, but a successful injection can provide pain relief lasting anywhere from three to six months, and in some cases, even longer. This window of relief is often used to allow patients to begin a rehabilitation program without pain. Due to the potential for cumulative side effects, medical guidelines generally limit the number of corticosteroid injections to no more than three or four times per year in a single area. Physicians typically recommend spacing these injections out by at least twelve weeks to minimize risk.
Risks, Side Effects, and Post-Procedure Guidance
While steroid injections are generally considered safe, patients should be aware of potential side effects and risks. A common, temporary reaction is a “steroid flare,” which is a brief increase in pain and inflammation at the injection site that occurs within one to three days after the procedure. This flare affects about twenty percent of patients and generally resolves within five days.
Less common but more serious risks include infection, which is rare but requires immediate medical attention, and the potential for tendon weakening or rupture with repeated injections. Localized side effects can include fat atrophy, where the fat cells under the skin at the injection site deteriorate, causing a visible dimpling or depression. Patients with pre-existing conditions like diabetes should monitor their blood sugar closely, as the steroid can cause a temporary elevation in glucose levels.
Following the procedure, it is recommended to avoid strenuous activity, such as heavy lifting or high-impact exercise, for a period of twenty-four to seventy-two hours. Applying ice to the injection site can help manage any immediate soreness or swelling. It is also advised to avoid submerging the hip in water, such as in a pool or bath, for up to two days to prevent the slight risk of infection.
Other Non-Surgical Treatment Options
Corticosteroid injections are typically considered when first-line conservative treatments have failed to resolve the pain of hip bursitis. The initial approach focuses on activity modification, which involves avoiding movements or positions that aggravate the bursa, such as sleeping on the affected side. Non-steroidal anti-inflammatory drugs (NSAIDs) are often used to help manage pain and reduce generalized inflammation in the short term.
Physical therapy is a fundamental component of conservative management, aiming to address the underlying biomechanical issues contributing to the bursitis. This includes stretching exercises for the iliotibial band (ITB) and gluteal muscles to improve hip flexibility. Rehabilitation also focuses on strengthening the gluteal muscles (gluteus medius and minimus) through exercises like side-lying clamshells and hip abduction to improve stability. For most cases of hip bursitis, these conservative measures ultimately resolve the condition, with success rates often exceeding ninety percent.