Anesthesiology | Interventional Pain Medicine
Assistant Professor — University of Toronto
Interventional Pain Physician — Afiya Spine & Pain Institute
Staff Anesthesiologist — Scarborough Health Network
Greater trochanteric pain syndrome is a common cause of pain on the outside of the hip.
The greater trochanter is the bony bump on the outside of the upper thigh bone. Pain in this area may involve the bursa, the tendons around the outside of the hip, the thick band of tissue along the outside of the thigh, altered walking mechanics, or a combination of these.
Many patients describe pain over the side of the hip, pain when lying on that side, pain with walking or stairs, or tenderness when pressing over the outside of the hip. Pain may also travel down the outside of the thigh.
This procedure may include two related parts.
The first part is a diagnostic block. Local anesthetic is placed near small sensory nerves around the back edge of the outside hip bone. Doctors may refer to these as small nerves from the femoral nerve.
The second part is a steroid injection around the outside hip bursa area. The steroid is intended to reduce local inflammation and provide temporary pain relief.
The diagnostic block helps determine whether you may be a candidate for greater trochanteric bursa radiofrequency ablation. The steroid injection may help provide pain relief while the response to the block is assessed and, if appropriate, while greater trochanteric bursa radiofrequency ablation is being considered or scheduled.
This procedure is most commonly considered for persistent pain on the outside of the hip when symptoms remain significant despite medication, physiotherapy, activity modification, exercise, stretching, walking aids, or previous injections.
The steroid injection portion is intended to reduce pain and local inflammation. The diagnostic block portion is a test. The goal of the block is not long-term relief by itself, but to determine whether the targeted sensory nerves are carrying a meaningful part of your pain on the outside of the hip.
The broader goal is to reduce pain enough that you can walk more comfortably, sleep better, and participate more actively in physiotherapy, strengthening the muscles on the outside of the hip, walking mechanics, and other rehabilitation strategies.
The greater trochanteric bursa radiofrequency ablation technique we use is based on treating small sensory nerves near the back edge of the outside hip bone. These nerves are thought to carry some of the pain from this area.
A meaningful temporary response to the diagnostic block supports the idea that these small nerves are contributing to your pain. In that case, we may discuss greater trochanteric bursa radiofrequency ablation, which is a longer-lasting treatment aimed at the same area.
In simple terms, X-ray guidance is used to find the outside hip bone, and the medication is placed at two small target areas along its back edge. The diagnostic block is considered helpful when it produces meaningful temporary relief during the numbing window.
Tell us if you have hip replacement surgery booked within the next 6 months. We generally do not want to inject steroid around the hip area if this could delay your surgery.
Tell us if you already have a hip replacement, have had recent hip surgery, have an active infection, are taking antibiotics, or have had a recent major change in your health.
If you already have a hip replacement and have persistent pain on the outside of the hip, your surgeon should assess the hip replacement before nerve procedures are considered. Problems such as infection, loosening, fracture, instability, or other surgical complications need to be ruled out first.
You usually do not need to fast for this procedure unless you are specifically told otherwise.
The injection is quick, but the full visit includes check-in, assessment, preparation, and recovery.
Most patients should expect the full appointment to take approximately 60 to 90 minutes, although this can vary depending on clinic flow that day.
The technique is based on treating small sensory nerves that are thought to travel near the back edge of the outside hip bone. The target is not inside the hip joint.
Most patients describe:
Local anesthetic is used to reduce discomfort. The procedure is usually brief.
The numbing medication from the diagnostic block usually lasts for several hours. This is the most important part of the test.
During this time, pay attention to whether your usual pain on the outside of the hip is better when you do the activities that normally bring it on. This may include walking, stairs, standing, getting in and out of a car, or lying on the affected side.
Do not simply go home and rest for the full numbing period. The test is most useful when you gently test your usual painful activities in a safe and controlled way.
You may walk and do normal light activity after the procedure. Avoid unusually strenuous activity for the rest of the day.
Log your pain level out of 10 every hour for 6 hours after the injection.
Also write down:
Bring your pain log to your follow-up appointment. Your pain log helps determine whether greater trochanteric bursa radiofrequency ablation is appropriate.
The diagnostic block is expected to work only during the numbing window.
The steroid portion may take several days to work. Relief from steroid injection is variable and often temporary. Some patients have relief for weeks to a few months, some have partial relief, and some do not improve.
It is common to have temporary soreness or a pain flare before the benefit from the steroid injection becomes clear.
The next step depends on how much relief you had during the numbing window and how long the steroid benefit lasts.
If your usual pain on the outside of the hip clearly improves during the numbing window, this supports the targeted sensory nerves as a meaningful pain pathway. In that case, we may discuss greater trochanteric bursa radiofrequency ablation.
If your pain does not improve during the numbing window, that is still useful information. It suggests that greater trochanteric bursa radiofrequency ablation may be less likely to help, or that another pain source may be more important.
Some patients have more than one source of hip, back, buttock, or leg pain. This procedure may help pain on the outside of the hip from the greater trochanter area, but it may not explain or treat all of your symptoms.
Keep the injection sites dry for 24 hours. Remove bandages after 24 hours.
Greater trochanteric bursa block and steroid injection is generally a low-risk procedure when performed with image guidance and sterile technique.
The most common issues are temporary soreness, bruising, lightheadedness, temporary increase in pain, temporary local numbness, or temporary irritation after the injection.
Uncommon risks include bleeding, infection, allergic reaction, medication entering a blood vessel, temporary numbness or weakness, or worsening pain.
Steroid injection can rarely cause skin lightening, local fat thinning, tendon irritation, or temporary elevation in blood sugar. Repeated steroid injections may be limited depending on your situation.
Steroid injection near the hip before hip replacement surgery may delay surgery because of infection-risk concerns. Tell us if you have hip replacement surgery booked within the next 6 months.
Seek medical attention if you develop fever, worsening redness or swelling at the injection site, drainage from the injection site, severe worsening pain, or new leg weakness that does not settle.
The procedure itself, including the clinic visit and use of X-ray guidance, is covered by OHIP.
OHIP does not cover the cost of medications used or prescribed, such as local anesthetic, steroid medication, contrast dye, or other medications. These costs may be covered by private insurance.
The medication cost is usually in the range of $25 to $100, depending on the extensiveness of the procedure, but this may vary.
Unless you are told otherwise, you may usually take your regular medications. Blood thinners require separate review.
Tell us before the procedure if you take blood thinners or antiplatelet medications. Do not stop them on your own. We will give you specific instructions based on the medication and your medical history.
Tell us before the procedure if you have ever had an allergy or serious reaction to contrast dye, local anesthetic, steroid medication, or antiseptic skin-cleaning solution.
Tell us if you have diabetes, an active infection, are taking antibiotics, are pregnant or may be pregnant, have hip replacement surgery booked within the next 6 months, or have had a recent major change in your health.
Afiya Spine & Pain Institute
301 - 15 Wellesley St W, Toronto, ON M4Y 1G1
Phone: 416-413-7999 | E-Fax: 416-641-4520
For questions or concerns after your procedure, contact the clinic.