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Thursday, August 28, 2014
Arthritis and Rheumatism
How is the Steroid Injection into the Hip Joint is Done?
Can you explain how the steroid injection into the hip joint is done and is it always done using an X-Ray?
By "steroid injection" I'm going to assume that you mean a corticosteroid injection. The term "steroid" refers to a chemical that has a specific chemical structure that is similar to cholesterol. Corticosteroids are natural or man-made drugs that have a steroid chemical structure and are similar to the hormones made the cortex (outer part) of the adrenal gland. They are not at all the same thing as the anabolic steroids that we've heard about so much in the news lately. Anabolic steroids are natural or man-made versions of the male sex hormone testosterone.
Corticosteroids are used for a variety of reasons, many of which rely on these drugs' powerful anti-inflammatory effects. If your physician has suggested a corticosteroid injection in your hip it is most likely to control inflammation. If you are not sure why an injection has been recommended, you should discuss it with your physician until you understand your treatment clearly. Corticosteroid injections should only be performed by qualified and experienced physicians who are both familiar with the technique and with the guidelines for the uses of these medications.
There are actually several different kinds of problems that could be treated with these injections either in or around the hip joint. It's impossible to guess which is the one that fits your question, so I'll talk a little bit about some common ones. A very common "hip" injection is not for the hip at all. If your pain is on the outer part of your hip and if the outer side of your hip "snaps" when you walk, then your physician might be planning to inject a fluid filled sac called that greater trochanteric bursa. Bursae act like lubricating pads around muscles and joints and the one on the outside of the hip often becomes inflammed (bursitis). Corticosteroid injections often relieve the symptoms long enough for the bursitis to be treated with either rest or controlled exercise. This is done with a simple injection to the side of the hip.
If your pain in mostly in your groin instead of on the outer part of your hip, then your physician might be considering an injection of the hip joint itself or injecting around a nerve or tendon in the hip area. These injections are done for both treatment and also for diagnosis of certain hip problems. Corticosteroid injections for osteoarthritis (OA for short) of the hip are common. In fact, a paper released last summer in the journal Arthritis and Rheumatism showed that corticosteroid injections for hip OA reduced pain by 50% and pain relief lasted up to 3 months in some patients.
The injection into the hip joint itself is a little more tricky than the bursitis injection mentioned already. It is often given during fluoroscopy (live X-ray) or some other means of imaging. The physician use the imaging to guide the placement of the needle into the hip joint itself. While the injection only takes a few minutes, the whole procedure may take around a half-hour to an hour. A common way to do it is to have you lie on an X-ray table. The physician may want you to have an IV so they can give you medication to relax your muscles. They clean a small patch of skin on your hip and inject a small amount of numbing medicine. Then, while watching with the fluroroscope they guide a very flexible needle into the hip joint and release a little bit of contrast agent (dye) that they can see with the fluroscope. The dye helps them confirm that they are in the hip joint and not outside of it. The very flexible needle (called a spinal needle) is used to help prevent any damage to the cartilage in your hip joint. After the dye confirms that they are in the hip joint, they inject a mixure of corticosteroid and anesthetic (numbing medicine). Once the injection is done, they usually have you rest on the table for a little while (around 20 minutes). It often takes a few hours for the medicine to reduce your pain.
Mark A Merrick, PhD, ATC
School of Health and Rehabilitation Sciences
The Ohio State University