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鈥檛 show tissue, how is that useful?
Should I have an MRI to determine where things really are amiss?
E.L.A.
The diagnosis of 鈥渂ursitis鈥� of the hip is usually made by a person鈥檚 medical history and a physical exam.
The greater trochanteric bursa is located directly on聽top of the 鈥減oint鈥� of聽the hip, but the current understanding of this common problem is that it鈥檚 more聽likely related to聽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 鈥渂lind,鈥� 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鈥檚 鈥渏ust aging鈥� and 鈥渢hin skin.鈥� Is there any reason for this to be happening? What can I do to stop it? My arms look as if I鈥檝e been beaten up. My mother had this also.
S.F.
鈥淪enile purpura鈥� is the term given to easy bruising found in older people when no specific cause can be found. 鈥淪enile鈥� means 鈥渉aving to do with aging,鈥� from the Latin 鈥渟enex鈥� for 鈥渙ld聽man.鈥� It has an unfortunate connection to dementia because the term 鈥渟enile dementia鈥� used to be used for all types of dementia, especially Alzheimer鈥檚 disease. It is thankfully no聽longer used.
The diagnosis of senile purpura can usually be made by a careful history and聽physical exam, but blood testing is聽sometimes done to exclude less common, and more concerning, causes of easy bruising.
Treatment usually isn鈥檛 required. Sometimes vitamin A-derived skin creams are used to help slow skin aging, which reduces bruising. A diet high in plants 鈥� especially a specific set of compounds called bioflavonoids 鈥� may improve the bruising tendency.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
