Imaging helps guide 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. The pain management nurse recommends my orthopedist do it because they use X-ray to guide the injection. But if Xrays don’t show tissue, how is that useful? Should I have an MRI to determine where things really are amiss?

E.L.A.

Answer: 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. 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.

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.

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?

S.F.

Answer: “Senile purpura” is the term given to easy bruising found in older people when no specific cause can be found.

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.

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