Literature on cortisone injections

[edjohnson]

I haven't been able to squat for 2 months due to trochanteric bursitis that I just can't shake with conservative methods. I have never had a cortisone injection but this may be the time I need one. I am wondering if you could point me to any literature that may influence my decision for against getting one. If I am not mistaken, most lifters here usually advise to avoid them but I am unsure why.

[Mark Rippetoe]

You can google this as easily as we can. I don't have a list of references at hand.

[edjohnson]

You can google this as easily as we can. I don't have a list of references at hand.

I was looking for an explanation or a source for an alternative view but if you don't have it that's alright. Google will only tell me what I already know.

[Will Morris]

I haven't been able to squat for 2 months due to trochanteric bursitis that I just can't shake with conservative methods. I have never had a cortisone injection but this may be the time I need one. I am wondering if you could point me to any literature that may influence my decision for against getting one. If I am not mistaken, most lifters here usually advise to avoid them but I am unsure why.

What diagnostic procedures / tests have been completed to diagnose greater trochanteric bursitis? The vast majority of these cases ( approximately 80% of greater trochanteric pain syndrome) are not caused by bursitis, but, rather, due to tendinitis / tendinosis / partial tear of the gluteus medius. A confirmed diagnosis of greater trochanteric bursitis versus lateral hip pain consistent with greater trochanteric pain syndrome would have profound implications on what is an appropriate treatment.

[JFord]

I haven't been able to squat for 2 months due to trochanteric bursitis that I just can't shake with conservative methods. I have never had a cortisone injection but this may be the time I need one. I am wondering if you could point me to any literature that may influence my decision for against getting one. If I am not mistaken, most lifters here usually advise to avoid them but I am unsure why.

I’m too lazy to do a lit search on this but greater trochanteric bursal injections are something I have a lot of clinical experience with. I’ve done them for years though this brand of bursitis is fairly rare in my practice.

The reason I’m willing to sound off on this procedure is simple. I’ve probably done about 15 or 20 of them in a 30+ year internal medicine practice. I may have had a treatment failure that I don’t remember but I’m pretty damn sure that I’m batting close to a thousand with this one.

I’ve never ordered a single test to verify my diagnosis and have diagnosed this exclusively on clinical grounds only. It may be that I’m more miserly in my patient selection than your doctor. I have no way of knowing. Maybe I just have a magical touch but I doubt it. This procedure requires almost no actual skill.

All I can tell you is that few patients are more convinced that I’m a savior than those I’ve done greater trochanteric bursal injections.

Your mileage may vary. Choose wisely.

[edjohnson]

What diagnostic procedures / tests have been completed to diagnose greater trochanteric bursitis? The vast majority of these cases ( approximately 80% of greater trochanteric pain syndrome) are not caused by bursitis, but, rather, due to tendinitis / tendinosis / partial tear of the gluteus medius. A confirmed diagnosis of greater trochanteric bursitis versus lateral hip pain consistent with greater trochanteric pain syndrome would have profound implications on what is an appropriate treatment.

I am not sure how I or anyone would tell the difference. I will say its probably not a tear. I tore my hamstring on my right side months ago and that was much different.

There was no distinct precipitating factor that could have caused the pain in my left hip. I literally just woke up with it. I did do squats the day before but they weren't heavy at all. It was just a normal squat day.

My symptoms align mostly with trochanteric bursitis as described in the book Current Medical Diagnosis and Treatment 2022 by Lange

I’m too lazy to do a lit search on this but greater trochanteric bursal injections are something I have a lot of clinical experience with. I’ve done them for years though this brand of bursitis is fairly rare in my practice.

The reason I’m willing to sound off on this procedure is simple. I’ve probably done about 15 or 20 of them in a 30+ year internal medicine practice. I may have had a treatment failure that I don’t remember but I’m pretty damn sure that I’m batting close to a thousand with this one.

I’ve never ordered a single test to verify my diagnosis and have diagnosed this exclusively on clinical grounds only. It may be that I’m more miserly in my patient selection than your doctor. I have no way of knowing. Maybe I just have a magical touch but I doubt it. This procedure requires almost no actual skill.

All I can tell you is that few patients are more convinced that I’m a savior than those I’ve done greater trochanteric bursal injections.

Your mileage may vary. Choose wisely.

Apologies I don't fully understand your post. You are a doctor who has performed this procedure around a 1000 times with good results? Or you are a patient that has had them done on you 15 to 20 times?

I don't think there are any diagnostic tests you would do beyond a clinical diagnosis.

I have had this before and it seemed to go away when I would back off but this time its being stubborn.

[JFord]

Apologies I don't fully understand your post. You are a doctor who has performed this procedure around a 1000 times with good results? Or you are a patient that has had them done on you 15 to 20 times?

I don't think there are any diagnostic tests you would do beyond a clinical diagnosis.

I have had this before and it seemed to go away when I would back off but this time its being stubborn.

I’m a physician (an internist) who’s done this procedure for patients 15 to 20 times in my career to date. I’ve had a good result just about every time.

1) None of my patients experienced complications and ALL seemed to be significantly better afterwards.

2) I’ve never ordered any tests to “confirm” my diagnosis but have relied only on the patient’s history and physical exam.

3) Maybe my great results are due to either my stellar patient selection or to my superb technique (although the procedure is so easy, a somewhat intelligent chimpanzee could do it).

4) Is it possible that I’m injecting people who have a disease different than the one I THINK I’m treating (as alluded to by Will’s post)? Yep. But if that’s the case, it apparently doesn’t seem to matter: my patients’ condition improves immediately afterwards and without complications. The immediacy of results is due to the lidocaine I inject along with the steroids (which would take hours to kick in). However, the patients generally achieve a longterm cure.

Is this more clear?

[jeremyw]

I had a cortisone injection for bursitis in my left hip 11 years ago. The bursitis was diagnosed by noted inflammation on an mri. 2 weeks later I partially tore my glute tendon near the injection site where it inserts into the femur while doing strongman yoke runs. I did not search this board first. Do an IT band release and then work the area religiously with a lacrosse ball. You can use powerlifting briefs to relieve pressure on the area while you squat. Also fix your diet.

[JFord]

I had a cortisone injection for bursitis in my left hip 11 years ago. The bursitis was diagnosed by noted inflammation on an mri. 2 weeks later I partially tore my glute tendon near the injection site where it inserts into the femur while doing strongman yoke runs. I did not search this board first. Do an IT band release and then work the area religiously with a lacrosse ball. You can use powerlifting briefs to relieve pressure on the area while you squat. Also fix your diet.

Sorry you had that complication. You didn't say what type of hip bursa was involved or how the injection was performed so I can't really comment on it.

But have I ever had a complication of any kind from a steroid injection? Gosh and golly yes!

I had a beautiful, young woman as a patient who developed a rather unsightly ganglion cyst in the back of her wrist. She'd had it for a long time. Then she sees Dr. Ford. Bad move for her unfortunately. I drained and injected it simultaneously with steroids. Got a great result but apparently some of my magic elixir extravasated into the muscle and caused myonecrosis (wasting away of the muscle). She was left with a cavity in her arm. It looked terrible but she wasn't mad and didn't sue me (actually keeping me as her doctor).

I felt HORRIBLE though and never injected a ganglion after that. Now I smash 'em with a bible like any self-respecting Victorian doctor would (kidding!).

Now ask me how I COMPLETELY screwed up the diagnosis of an achilles tendon rupture. Hint: the correct physical exam test is called the Thompson Test. It is NOT the ability of the patient to plantar flex against resistance (unless you like false negatives). Are you reading this Will? I hope you learned this during your PT training in a way different than how I learned it!

[edjohnson]

I’m a physician (an internist) who’s done this procedure for patients 15 to 20 times in my career to date. I’ve had a good result just about every time.

1) None of my patients experienced complications and ALL seemed to be significantly better afterwards.

2) I’ve never ordered any tests to “confirm” my diagnosis but have relied only on the patient’s history and physical exam.

3) Maybe my great results are due to either my stellar patient selection or to my superb technique (although the procedure is so easy, a somewhat intelligent chimpanzee could do it).

4) Is it possible that I’m injecting people who have a disease different than the one I THINK I’m treating (as alluded to by Will’s post)? Yep. But if that’s the case, it apparently doesn’t seem to matter: my patients’ condition improves immediately afterwards and without complications. The immediacy of results is due to the lidocaine I inject along with the steroids (which would take hours to kick in). However, the patients generally achieve a longterm cure.

Is this more clear?

Yes thank you.
I guess its safe to assume that you have followed up with those patients for months/years after?
Due to the strange nature of pain itself and how it can many times be present without any type of real damage or inflammation, would you ever recommend a lidocaine only injection as a conservative approach?

I had a cortisone injection for bursitis in my left hip 11 years ago. The bursitis was diagnosed by noted inflammation on an mri. 2 weeks later I partially tore my glute tendon near the injection site where it inserts into the femur while doing strongman yoke runs. I did not search this board first. Do an IT band release and then work the area religiously with a lacrosse ball. You can use powerlifting briefs to relieve pressure on the area while you squat. Also fix your diet.

I have heard of this tennis ball/lacrosse ball approach. Do you have any video tutorials you would recommend? How exactly do you do it and at what frequency?