Ultrasound-Guided Corticosteroid Injections Relieve Chronic Lateral Hip Pain

Fran Lowry

September 18, 2010

December 22, 2009 — A peritendinous ultrasound-guided corticosteroid injection may be an effective treatment for patients with greater trochanteric pain syndrome associated with gluteus medius tendinopathy, according to a study published in the January issue of the American Journal of Roentgenology.

"Ultrasound is a technique that has gained widespread acceptance for musculoskeletal imaging and guiding interventions. This noninvasive, nonionizing imaging technique allows continuous monitoring of the needle position, which facilitates the performance of safe and precise cortisone injections," write Julie M. Labrosse, MD, from the University of Montreal Hospital Center, Quebec, Canada, and colleagues. "To our knowledge, a specific technique for ultrasound-guided cortisone injections in the treatment of gluteus medius tedinopathy has not been reported."

The aim of the study was to evaluate the effectiveness of the technique in the treatment of this condition, which primarily affects middle-aged and elderly women but can also affect young, active individuals.

The investigators prospectively evaluated 54 consecutive patients (48 women, 6 men) who ranged in age from 35 to 78 years (mean, 54.7 years) and whose body mass index ranged from 20 to 35.5 kg/m2 (mean, 26 kg/m2).

The diagnosis of medial gluteus tendinopathy was established in all patients by a specialist in physical medicine and rehabilitation. The criteria for such a diagnosis included a history of trochanteric pain for at least 6 weeks, reproducibility of the pain by local pressure on the greater trochanter, aggravation of the pain by resisted isometric hip abduction and passive hip adduction, and the ineffectiveness of pain medication and physiotherapy.

Pain assessment using a 10-cm visual analog scale was obtained at each patient's initial clinical evaluation. Patients had to have a pain-intensity score of at least 5.

An ultrasound study of the symptomatic hip was performed.

Patients were then prepared for the cortisone injection with an injection of 2% lidocaine, which was given under continuous ultrasound real-time monitoring.

This was followed by a gluteus medius peritendinous ultrasound-guided injection of 30 mg of triamcinolone combined with 3 mL of bupivacaine 0.5%.

Patients were instructed not to take any other pain or anti-inflammatory medication.

The investigators report that a clinically and statistically significant improvement in pain level, which was defined as a 30% or more reduction in the visual analog scale pain score, was seen in 72% of the patients (n = 30) 1 month after treatment.

The ultrasound-guided corticosteroid injection produced a 55% average reduction of pain level on the visual analog scale. Before treatment, the mean visual analog scale pain score was 6.4 cm; after treatment it was 2.9 cm (P < .001).

The majority of the patients (70%) were satisfied with the results of the intervention, the authors report.

In pointing out the study's limitations, the authors note that the technique is dependant on sonographer experience and skill, as is the case with any ultrasound procedure.

The absence of an ultimate reference standard for the diagnosis of gluteus tendinopathy is another limitation.

Finally, the study was not randomized and controlled, and the 1-month follow-up period was not long enough to assess the long-term efficacy of the treatment.

The authors write that the use of ultrasound for guiding musculoskeletal procedures has increased during the past several years. The technique has several advantages, including its soft tissue imaging capabilities, which can diagnose without the need for contrast injection. In addition, it does not expose the patient to ionizing radiation and the risks of iodine allergy.

The authors call for randomized trials to clarify the level of scientific evidence in favor of ultrasound-guided corticosteroid injection for the treatment of this chronic and painful condition.

Dr. Labrosse has disclosed no relevant financial relationships.

Am J Roentgenol. 2010;194:202-206.


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