An injection into an inflamed bursa, most often at the hip or shoulder.
What it is
A bursa is a small sac of fluid that lets tissues slide past each other. When it is inflamed it gets very sore to the touch. A targeted injection settles it.
See every joint and tendon we treat with PRP, bone marrow or fat on our PRP injections in St. Louis page.
What we use it for
- Trochanteric bursitis at the outer hip
- Subacromial bursitis at the shoulder
- Lasting outer hip pain after a fall
What happens during a bursa injection?
- Done with ultrasound to guide the needle, in the clinic room.
- A few minutes.
- Often strong relief within days.
- Paired with physical therapy, because bursitis usually comes from how the tendon is loaded.
What are the risks of a bursa injection?
Bursae close to the skin carry one clear risk. The skin can thin, with loss of pigment at the injection site. That shows more on darker skin. Where the bursa lies against a tendon, the tendon can weaken. That is why repeated injections are avoided and loading exercises are stressed instead. Infection risk is low with clean, sterile technique.
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How we judge whether it worked
Relief is often fast and strong. That makes it tempting to treat it as the end of the story. It usually is not.
Bursitis nearly always comes from how the tendon next to it is being loaded. If you do not deal with that, it comes back. That is why the injection is paired with a loading program and not offered alone.
What should you avoid after a bursa injection?
You can usually drive yourself. Keep pressure off the area for a few days. For a hip bursa, that means do not sleep on that side. Start the loading exercises we give you once the first soreness settles. Without them, it is close to certain to come back. Tell us about any growing redness or swelling.
How the procedure is actually done
A bursa is a thin sac of fluid that lets tendon glide over bone. When it is inflamed, we inject the space under ultrasound guidance. That matters more than people think. Landmark-guided injections (aimed by feel alone) around the hip and shoulder miss the target a large share of the time. Ultrasound shows both the space and the needle inside it.
Who is a good candidate for a bursa injection?
It suits inflammation that is confirmed on exam and imaging. That means the greater trochanter at the hip, the subacromial space at the shoulder, and now and then the elbow or knee. It is a weaker fit when the real problem is tendon degeneration (the tendon breaking down) and not bursal inflammation. That is common at both hip and shoulder. Repeated steroid injection into a degenerative tendon is best avoided.
Why the order matters here
Treatment aimed at the wrong spot gives a poor result. Worse, it teaches you nothing. That is why we confirm the target before we commit to anything lasting. It costs one visit, and it shifts the odds in a big way. Patients who come to us having had several unsuccessful injections elsewhere almost always had them without that step.
Common questions
Will the bursitis come back?
It can, if the loading problem behind it is not dealt with. That is why the injection is paired with rehab.
Why does it need ultrasound?
Because landmark-guided injections around the hip and shoulder often miss. Guidance confirms the medicine is in the space we aimed for.
Joint Injection explains what that looks like.
How many can I have?
Your need decides, not a fixed number. We avoid repeat steroid around a degenerative tendon. If one injection does not bring lasting change, the diagnosis is worth a second look.
Is bursitis the real diagnosis?
Often it is one part of a bigger picture. That picture also takes in the tendon and the way the joint is loaded. Treating only the bursa tends to give short-lived results.
Hip Pain goes through it in detail.
How long does a hip bursitis injection take to work?
Relief often comes within days, and it is often substantial. The injection itself takes a few minutes in the clinic room under ultrasound. Fast relief is not the finish line, though. Bursitis is nearly always driven by how the tendon next to it is loaded. So the loading exercises we give you are what keep the result.
How do you get rid of hip bursitis for good?
Treat the load, not only the bursa. Hip bursitis nearly always comes from how the tendon beside it is being loaded. The injection settles the inflamed sac. The loading program we give you changes what inflamed it. Skip the exercises and the bursitis reliably comes back. If one injection does not bring lasting change, the diagnosis is worth a second look.
Can I sleep on my side after a hip bursa injection?
Not on the treated side for a few days. Keep pressure off the area while it settles. For a hip bursa, that means do not sleep on that side. You can usually drive yourself home. Start the loading exercises once the first soreness settles. Call us if redness or swelling gets worse.
Sources
- Nchinda NN et al. Clinical Management of Olecranon Bursitis: A Review. The Journal of hand surgery, 2021. PubMed 33840568
- Pianka MA et al. Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology. SAGE open medicine, 2021. PubMed 34158938
- Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 2020. PubMed 31908149
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