Dr. Roach: What kind of doctor gives a bursitis injection?
Dear Dr. Roach: I have been diagnosed with bursitis on my left hip, and my pain management doctor says she can give me an injection to help. I had one last year by an orthopedist. The pain management nurse recommends my orthopedist do it because they use X-ray to guide the injection. But if X-rays don’t show tissue, how is that useful? Should I have an MRI to determine where things really are amiss?
Dear E.L.A.: The diagnosis of “bursitis” of the hip is usually made by a person’s medical history and a physical exam. The greater trochanteric bursa is located directly on top of the “point” of the hip, but the current understanding of this common problem is that it’s more likely related to the tendons that run over the area (especially the gluteus minimus and medius) than to the actual bursa. The bursa is a structure that provides lubrication to the area. Injection of steroid into the area is a common and usually effective treatment.
The injection can be done “blind,” with no imaging to guide the doctor, but is often done with the assistance of ultrasound or X-ray. Ultrasound is preferred since it can be done much more easily and portably. The handheld portable ultrasound is poised to revolutionize many aspects of diagnosis and bedside procedures.
MRI is not generally used to guide procedures; however, MRI is excellent at visualizing soft tissue if there is uncertainty about the diagnosis. Some studies show that ultrasound-guided injections have better results than the blind injections physicians have been doing for decades, based on surface landmarks.
Pain management doctors, orthopedists, rheumatologists and even some general internists all may be skilled at joint and soft tissue injection.
DEAR DR. ROACH: I am a 66-year-old woman of British-Irish ancestry. In the past few years, I have developed severe bruises on my arms in response to the slightest bump against objects, or simply wearing a watch or bracelet. My doctor says it’s “just aging” and “thin skin.” Is there any reason for this to be happening? What can I do to stop it? My arms look as if I’ve been beaten up! My mother had this also.
Dear S.F.: “Senile purpura” is the term given to easy bruising found in older people when no specific cause can be found. “Senile” means “having to do with aging,” from the Latin “senex” for “old man.” It has an unfortunate connection to dementia because the term “senile dementia” used to be used for all types of dementia, especially Alzheimer’s disease. It is thankfully no longer used.
The diagnosis of senile purpura can usually be made by a careful history and physical exam, but blood testing is sometimes done to exclude less common, and more concerning, causes of easy bruising.
Treatment usually isn’t required. Sometimes vitamin A-derived skin creams are used to help slow skin aging, which reduces bruising. A diet high in plants -- especially a specific set of compounds called bioflavonoids -- may improve the bruising tendency.