Indications
Injection of the abductor tendon is a useful diagnostic and therapeutic procedure for tendonitis at the insertion of the gluteal musculature into the greater trochanter.
Techniques
After informed consent is obtained, the patient is positioned lying on the side facing the clinician with the painful hip exposed. The hips and knees are flexed and the affected hip adducted. The hip is palpated above the tip of the trochanter to determine the point of maximal tenderness. A 3.5-in. (9-cm), 21-gauge needle is inserted at the point of maximal tenderness and directed toward the tip of the greater trochanter, approximating the insertion of the gluteal fasciae. The needle is advanced vertically to a depth that would reach the hip abductor tendon. This depth would vary from one patient to another, which is estimated by palpation of the hip abductor tendon. In obese patients, a lumbar puncture needle would have to be used to reach the tendon area. After negative aspiration, the area of maximal tenderness is injected with a 10-mL mixture of 10 mg of triamcinolone acetonide (or equivalent) and local anesthetic.
Comments
The injection is not placed into the tendon but rather into the peritendinous region. Wide infiltration with a corticosteroid and local anesthetic mixture is recommended. Tender points in the vicinity of the hip joint are often associated with osteoarthritis of the hip. Injection of these sites may provide significant pain relief.
Complications
Injecting directly into the tendon rather than into the peritendinous region may result in damage to the abductor tendon of the hip.
Source: Physical Medicine and Rehabilitation – Principles and Practice
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