Introduction

Trochanteric bursitis is a common condition that causes lateral hip pain, i.e. on the outer side of the hip, often making everyday activities like walking, climbing stairs, or even lying on the affected side, uncomfortable.¹ It occurs when the trochanteric bursa, a small fluid-filled sac that cushions the greater trochanter of the femur, becomes inflamed. This bursa plays an important role in reducing friction between the hip bone and surrounding soft tissues, but when irritated, it can lead to persistent discomfort and reduced mobility.²

There are several causes of trochanteric bursitis, with overuse, direct trauma, muscle imbalances, and biomechanical issues being the most common³. Runners, athletes, and individuals with poor posture, obesity, or lower back problems are more prone to develop the condition. It can also be linked to underlying issues, like hip osteoarthritis or tendon injuries.⁴

Treatment typically starts with rest, anti-inflammatory medications, and physical therapy, but when pain persists, corticosteroid injections are often used to provide relief. While these injections can be highly effective in reducing inflammation and alleviating pain, concerns remain about their long-term effectiveness and potential risks.⁴

This article provides information on how well the corticosteroid injection works for trochanteric bursitis and the possible downsides to consider before choosing this treatment.

Understanding trochanteric bursitis

Pathophysiology

Trochanteric bursitis occurs when the trochanteric bursa, a fluid-filled sac that cushions the outer hip, becomes inflamed.³ This inflammation can result from repetitive stress, direct trauma, prolonged pressure (such as sleeping on one side), or underlying issues like muscle weakness or poor posture. As the bursa swells, it causes discomfort and friction between the greater trochanter and the surrounding soft tissues, leading to pain and mobility restrictions.³

Symptoms

The most noticeable symptom is pain on the outer side of the hip, which can range from a dull ache to sharp discomfort, depending on the severity of the inflammation.^1,2,3 Other symptoms include:

• Swelling or soreness of the hip joints
• Redness around the joint
• Limping
• Sharp pain at the side of the hips
• Clicking sensation

The pain often worsens with activities such as:

• Walking, especially on uneven surfaces
• Climbing stairs or standing up from a seated position
• Lying on the affected side can disrupt sleep
• Prolonged standing or repetitive hip movements

In some cases, pain can radiate down the outer thigh toward the knee, mimicking conditions like sciatica. Some people also report hip stiffness, a feeling of tightness, or mild swelling around the hip. The area may be tender to the touch, and simple movements like crossing the legs or putting on shoes can become uncomfortable.⁴

Diagnosis

A diagnosis of trochanteric bursitis is primarily clinical, based on a patient’s symptoms and a physical examination. A healthcare provider will typically:

• Palpate the outer hip to check for localised tenderness over the greater trochanter³
• Movement tests, such as resisted hip abduction or single-leg stance, should be performed to assess pain triggers³
• Check for muscle imbalances or gait abnormalities that might be contributing to the condition³

If symptoms persist, imaging tests such as X-ray, MRI, ultrasound and bone scans may be carried out:

• Ultrasound can reveal bursa inflammation or fluid accumulation³
• MRI may be ordered to rule out related issues, such as gluteal tendinopathy, hip osteoarthritis, or lumbar radiculopathy (which can cause similar pain patterns)³

Mechanism of action

Corticosteroid injections help reduce inflammation and pain by directly targeting the affected area, such as the trochanteric bursa. When injected, the corticosteroid enters cells and binds to glucocorticoid receptors, triggering a series of reactions that suppress inflammatory processes.⁵ This reduces the production of substances, like prostaglandins, leukotrienes, and cytokines, which are responsible for swelling and pain.⁵

In addition to reducing inflammation, corticosteroids also limit the movement of immune cells to the irritated area, decrease capillary permeability and help reduce swelling.⁵ These combined effects provide fast relief, often within a few days of the injection.⁶

The effects of the drug can persist even after it has left the body because of changes at the cellular level that continue to suppress inflammation.⁶

However, while corticosteroid injections can be highly effective in the short term, they do not treat the root cause of trochanteric bursitis, such as muscle imbalances or overuse. For long-term relief, they should be combined with physical therapy and lifestyle modifications. Additionally, repeated use may carry risks, including weakened tendons and potential side effects.⁷

Procedure

Corticosteroid injections can be administered in two ways:

Blind Injection – This technique relies on the clinician’s knowledge of anatomy and palpation to guide the needle into the affected area without imaging assistance. While widely used and often effective, it carries a higher risk of inaccurate placement, which may reduce effectiveness or inadvertently affect surrounding tissues.⁸

Figure 1. Corticosteroid Injection into the trochanteric bursitis¹

Ultrasound-guided injection – A more precise approach, where ultrasound imaging helps visualise the inflamed bursa and surrounding structures. This allows for accurate needle placement, ensuring the medication is delivered directly to the target area. Research suggests that ultrasound guidance enhances effectiveness, improves pain relief, and reduces the risk of complications, such as injecting into nearby tendons or soft tissues.⁹

Figure 1. Corticosteroid Injection into the trochanteric bursitis using ultrasound¹⁶

These injections are typically performed in an outpatient setting with minimal downtime. Patients are often advised to rest and avoid excessive activity for a few days to maximise effectiveness.

Effectiveness of corticosteroid injections

Short-term relief (first 4-6 weeks)

Corticosteroid injections are known to provide quick and effective pain relief, particularly in the early weeks following treatment. Many patients experience a significant reduction in pain within a few days, with peak relief occurring around two to four weeks after the injection.¹⁰ This makes corticosteroid injections a popular option for those struggling with severe or persistent symptoms that have not responded to basic treatments like NSAIDs (non-steroidal anti-inflammatory drugs) or physiotherapy. Compared to oral pain medications, injections deliver the medication directly to the inflamed bursa, leading to faster and more targeted results.¹⁰

Long-term effectiveness

While the short-term benefits are widely recognised, the long-term effectiveness varies among individuals. Many patients experience a recurrence of symptoms within 3 to 6 months, especially if underlying issues such as poor biomechanics, muscle weakness, or repetitive strain are not addressed. Some studies suggest that repeated injections may lose effectiveness over time, and there are concerns about potential side effects, such as tendon weakening and joint damage with excessive use.¹⁰

Research on the effectiveness of corticosteroid injections beyond six months has shown mixed results. Some patients maintain relief, while others find that symptoms gradually return, requiring additional treatments or alternative interventions.¹⁰

Comparison with other treatments

For long-term success, corticosteroid injections are often most effective when combined with other treatments, particularly physiotherapy, which helps strengthen hip and core muscles to correct movement patterns and prevent recurrence.¹¹

Other treatments

• Physical therapy has been shown to provide lasting relief by addressing muscle imbalances, poor posture, and biomechanics that contribute to bursitis¹¹
• Shockwave therapy is a newer, non-invasive treatment that uses sound waves to stimulate healing in chronic cases of bursitis¹²
• Platelet-rich plasma (PRP) injection is an emerging option that uses the patient's blood platelets to promote tissue repair, showing promise for chronic and treatment-resistant bursitis cases¹³

While corticosteroid injections can be highly effective for immediate relief, they should be considered part of a broader treatment plan rather than a standalone solution for managing trochanteric bursitis in the long run.¹¹

Risks and side effects 

Short-term risks

While corticosteroid injections can relieve pain, they are not without risks. Some patients experience a temporary flare-up of pain at the injection site within the first 24 to 48 hours, which usually subsides on its own.⁷

Other possible short-term side effects include:

• Skin changes, such as localised atrophy (thinning of the skin) or depigmentation (loss of pigment), particularly if the injection is administered too close to the surface¹⁴
• Temporary elevation in blood sugar levels, which is especially important for individuals with diabetes. Blood sugar should be monitored closely following the injection¹⁴

Long-term risks

Repeated use of corticosteroid injections can have more serious consequences. One of the most concerning risks is tendon weakening or rupture, particularly affecting the gluteal tendons that attach near the greater trochanter. This can contribute to gluteal tendinopathy, which may worsen hip pain over time.⁷

Other long-term concerns include:

• Cartilage degeneration, especially with frequent or high-dose injections, may increase the risk of joint problems⁷
• Diminishing effectiveness, as some patients find that repeated injections become less effective over time, possibly due to tissue changes in the treated area⁷

Recommendations

Doctors usually recommend no more than three corticosteroid injections per year in the same area to avoid potential tissue damage. Getting injections too often can weaken tendons, wear down cartilage, make the treatment less effective over time and reduce the long-term benefits of the treatment.⁷

Summary

Corticosteroid injections are a common treatment for trochanteric bursitis, providing quick pain relief by reducing inflammation in the trochanteric bursa. They are particularly effective in the short term (4-6 weeks) but may not offer lasting relief if underlying issues like muscle imbalances or biomechanical problems are not addressed.

While generally safe, repeated injections can lead to tendon weakening, cartilage damage, and diminishing effectiveness. Most experts recommend no more than three injections per year. For long-term success, corticosteroid injections should be combined with physical therapy, lifestyle modifications, and alternative treatments like shockwave or PRP therapy when needed.

Corticosteroid injections are best suited for patients with severe pain that limits movement and those who haven’t responded to NSAIDs, rest, or physiotherapy. They can provide quick relief, making it easier to engage in rehabilitation. However, they may not be ideal for diabetics, as they can temporarily raise blood sugar or for those with gluteal tendinopathy, since steroids can weaken tendons. Patients with multiple injections in the same area may also see diminishing results. For long-term management, injections should be combined with physical therapy and biomechanical corrections to prevent recurrence.