Impact of fluoroscopic injection location on immediate and delayed pain relief in patients with greater trochanteric pai
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SCIENTIFIC ARTICLE
Impact of fluoroscopic injection location on immediate and delayed pain relief in patients with greater trochanteric pain syndrome Lisa J. Mao 1 & John B. Crudup 2 & Cody R. Quirk 3 & James T. Patrie 4 & Nicholas C. Nacey 5 Received: 5 February 2020 / Revised: 6 April 2020 / Accepted: 13 April 2020 # ISS 2020
Abstract Object The purpose of this study was to assess whether fluoroscopically guided corticosteroid injections into the extrabursal tissues, trochanteric (subgluteus maximus) bursa, or subgluteus medius bursa provide better immediate and short-term pain relief. Materials and methods All fluoroscopically guided corticosteroid injections performed over a 67-month period for greater trochanteric pain syndrome were retrospectively reviewed. Procedural images were reviewed by two musculoskeletal radiologists to determine the dominant injection site based on final needle positioning and contrast spread pattern, with discrepancies resolved by consensus. Statistical analysis of the association between pain score reduction and dominant injection site was performed. Results One hundred forty injections in 121 patients met the inclusion criteria. The immediate and 1-week post-injection pain reduction was statistically significant for trochanteric bursa, subgluteus medius bursa, and non-bursal injections. However, there was no statistically significant difference in the degree of pain reduction between the groups. There was statistically significant increase in the 1-week post-injection mean pain score compared with immediate post-injection mean pain score in the subgluteus medius bursa and non-bursal injection groups (p < 0.01) but not in the trochanteric bursa group. Conclusion Fluoroscopy is frequently chosen over blind injection or ultrasound guidance for trochanteric steroid injections in patients with a high body mass index. Our results indicate that fluoroscopically guided steroid injections into the trochanteric bursa and subgluteus medius bursa significantly reduced immediate and 1-week post-injection pain scores, as do non-bursal injections. Steroid injection into the subgluteus medius bursa and non-bursal sites may be less effective in maintaining pain reduction at 1-week post-injection. Keywords Greater trochanteric pain syndrome . Fluoroscopy-guided injections . Hip pain
Introduction Greater trochanteric pain syndrome (GTPS) is a common clinical entity which presents with lateral hip pain centered over the greater trochanter, generally reproduced with direct
* Nicholas C. Nacey [email protected] 1
Kaiser Permanente Northern California, Sacramento, CA, USA
2
Delaney Radiologists, Wilmington, NC, USA
3
Medical University of South Carolina, Charleston, SC, USA
4
University of Virginia Public Health Sciences, Charlottesville, VA, USA
5
Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
palpation. Hip pain from osteoarthritis in comparison typically presents with hip pain closer to the groin. A positive Trendelenburg sign a
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