Bursitis is a leading cause of hip and shoulder pain that is easily treated with injection therapies. Bursa are closed, fluid filled slippery sacs that allow tendons and muscles to slide over or under bone without getting injured from the rough boney surface. Overuse and trauma can cause the bursa to become inflamed and painful (bursitis), making every movement of the muscles and tendons in the area hurt. Traditional treatment involves rest, ice, NSAID’s and time.
A retrospective cohort study found that injecting the hip bursa with cortisone increased the odds of being pain free 5 years after a single injection by 2.7 times compared to those who did not receive a cortisone injection. This study makes clear that a steroid injection for hip bursitis (also known as Trochanteric bursitis) should be considered a first line therapy for hip bursitis. One might surmise that the same could be true for shoulder bursitis (called subdeltoid or subacromial bursitis) as well, although I’m not aware of a similar shoulder study.
Bursa are thin structures, sometimes just 1 mm thick. If the bursa is swollen and thick, it might be up to 4-6 mm thick. In either case, using an ultrasound to guide the placement of the injection dramatically improves accuracy, especially in the shoulder where the thin bursa is sandwiched between two muscle layers. Without ultrasound it is very difficult to be certain of the accuracy of the injection. With ultrasound, the needle tip and the bursae are clearly visualized and the clinician (and patient if they like to watch) can see when the needle tip is placed inside the bursa sac and watch the medicine being delivered.
If you have hip or shoulder bursitis and would like immediate pain relief an ultrasound guided injection might give long lasting relief.