Findings of the study published by Mitchell et al. (2018) demonstrate effectiveness of both palpation and image-guided injection of the trochanteric bursa with almost a similar clinical reduction in pain at 2 weeks with ultrasound-guided injections (84% reduction) versus landmark-guided injections (74% reduction) of the trochanteric bursa; however, ultrasound guidance significantly increases costs. Thus, according to Mitchell et al. ultrasound guidance for injection of trochanteric bursitis needs not be routinely used in all patients; rather, ultrasound guidance could be reasonably restricted to those patients who are extremely obese or who experience unacceptably high levels of procedural pain, inadequate therapeutic duration, or the overt failure of a prior anatomic landmark-guided injection.
NOTE: In contrast to the information above SonoSkills advises to do an ultrasound exam anyway because research has shown that 80% of trochanteric pain is not caused by the trochanteric bursa, but in many cases due to gluteal tendon problems. To know IF there is a bursa present, and IF there is an indication to inject, one should first do an ultrasound.