BJA Advance Access originally published online on October 29, 2004
British Journal of Anaesthesia 2005 94(1):100-106; doi:10.1093/bja/aei012
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Corticosteroid injections for trochanteric bursitis: is fluoroscopy necessary? A pilot study
1 Pain Management Centers, Departments of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA and Walter Reed Army Medical Center, Washington, DC, USA. 2 Department of Physical Medicine and Rehabilitation, Walter Reed Army Medical Center, Washington, DC, USA and Department of Radiology, Loma Linda University, Loma Linda, California, USA. 3 Pain Management Center, NYU School of Medicine, New York, USA. 4 MGH Pain Center, Deparment of Anaesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
* Corresponding author. E-mail: spc5_2000{at}yahoo.com
Background. Numerous studies have demonstrated that therapeutic injections carried out to treat a variety of different pain conditions should ideally be performed under radiological guidance because of the propensity for blinded injections to be inaccurate. Although trochanteric bursa injections are commonly performed to treat hip pain, they have never been described using fluoroscopy.
Methods. The authors reviewed recorded data on 40 patients who underwent trochanteric bursa injections for hip pain with or without low back pain. The initial needle placement was done blindly, with all subsequent attempts done using fluoroscopic guidance. After bone contact, imaging was used to determine if the needle was positioned on the lateral edge of the greater trochanter (GT). Once this occurred, 1 ml of radiopaque contrast was injected to assess bursa spread.
Results. The GT was contacted in 78% of cases and a bursagram obtained in 45% of patients on the first needle placement. In 23% of patients a bursagram was obtained on the second attempt and in another 23% on the third attempt. Four patients (10%) required four or more needle placements before a bursagram was appreciated. Attending physicians obtained a bursagram on the first attempt 53% of the time vs 46% for fellows and 36% for residents (P=0.64). Older patients were more likely to require multiple injections than younger patients.
Conclusions. Radiological confirmation of bursal spread is necessary to ensure that the injectate reaches the area of pathology during trochanteric bursa injections.
Presented at the XXIII Annual European Society of Regional Anaesthesia Congress, Athens, Greece, September 2004.
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