See Table 1 for a list of pharmaceuticals and equipment. TIMING AND OTHER CONSIDERATIONSĮarly corticosteroid injection frequently is the preferred treatment, because it has been shown to be effective with satisfactory duration of effect.
Diagnosis is confirmed by palpation of tenderness, and sometimes swelling, in the region of the bursa. 9 Friction from a tight iliotibial band, typically seen in runners, also can cause this problem. Leg-length abnormalities, obesity, rheumatoid arthritis, and osteoarthritis are associated factors in many patients.
Trochanteric bursitis, the primary indication for therapeutic injection at this site, usually is associated with chronic pressure or trauma to the area. The trochanteric bursa is located over the lateral prominence of the greater trochanter of the femur. This article focuses on the anatomy, pathology, diagnosis, and injection technique of the common sites for which this skill is applicable, including the greater trochanteric bursa, knee joint, pes anserine bursa, iliotibial band, and the prepatellar bursa. 3 – 8 Intra-articular injection of the hip is rarely performed by family physicians because this procedure is commonly performed with fluoroscopic guidance. 1 The hip and knee are sites of multiple injuries and inflammatory conditions 2 that lend themselves to diagnostic and therapeutic injection. The rationale, indications, contraindications, and general approach to this technique are discussed in the first article of the series.
#PES ANSERINUS SERIES#
This article, part of a series on diagnostic and therapeutic injections, reviews the hip and knee regions. The proper technique, choice and quantity of pharmaceuticals, and appropriate follow-up are essential for effective outcomes. Persistent pain and disability from iliotibial band syndrome respond to local injection therapy. Swelling and tenderness of pes anserine or prepatellar bursae can be relieved with aspiration and corticosteroid injection. Indications for corticosteroid injection include advanced osteoarthritis and other inflammatory arthritides, such as gout or calcium pyrophosphate deposition disease. Injection of the knee can be performed for viscosupplementation or corticosteroid therapy. For the knee joint, aspiration may be performed to aid in the diagnosis of an unexplained effusion and relieve discomfort caused by an effusion. Indications for greater trochanteric bursa injection include acute and chronic inflammation associated with osteoarthritis, rheumatoid arthritis, repetitive use, and other traumatic injuries to the area. In this article, the injection procedure for the greater trochanteric bursa, the knee joint, the pes anserine bursa, the iliotibial band, and the prepatellar bursa is reviewed. Joint injection of the hip and knee regions is a useful diagnostic and therapeutic tool for the family physician.
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