Hip pain can come from the joint itself, the tendons around the hip, a bursa, the lower back, or sometimes more than one structure at the same time. That overlap is one reason a carefully targeted injection can be useful.
An ultrasound-guided hip injection allows the clinician to see the needle, the target, and nearby structures in real time. Depending on the diagnosis, the injection may be placed inside the hip joint, around a tendon, into a bursa, or near another specific pain generator.
From my perspective as an orthopedic surgeon, the most important question is not simply, “Can we give an injection?” It is, “What structure are we targeting, what are we trying to learn or accomplish, and how will the result change the treatment plan?”
Why hip injections are different from many other injections
The hip joint is deep beneath muscle and close to important blood vessels and nerves. Unlike a superficial knee injection, the hip is not a joint that should be approached casually without imaging guidance.
The American College of Rheumatology strongly recommends ultrasound guidance for intra-articular corticosteroid injections of the hip. A systematic review found ultrasound-guided hip joint injections were substantially more accurate than landmark-guided injections. Read the ACR guideline and the accuracy review in the British Journal of Sports Medicine.
Ultrasound guidance offers several practical advantages:
- Real-time visualization of the needle
- Confirmation of the intended target
- No ionizing radiation
- Ability to examine tendons, bursae, fluid, and soft tissues during the same visit
- Greater confidence when anatomy is deep or difficult to palpate
- The ability to avoid visible blood vessels and other structures
Accuracy matters, but accuracy alone does not guarantee that an injection will solve the problem. The diagnosis, medication, timing, and rehabilitation plan still matter.
What conditions may be evaluated or treated?
Hip osteoarthritis
Hip arthritis commonly causes groin pain, stiffness, reduced rotation, difficulty putting on shoes, pain getting out of a car, and discomfort with prolonged walking.
The 2024 American Academy of Orthopaedic Surgeons guideline states that an intra-articular corticosteroid injection may be considered for short-term improvement in pain and function for symptomatic hip osteoarthritis. The same guideline recommends against hyaluronic acid injections for hip osteoarthritis because they have not shown better pain or function outcomes than placebo. Read the AAOS guideline summary.
A hip joint injection may be useful when:
- Pain is limiting rehabilitation or daily activity
- Oral medication is not appropriate or has not helped enough
- The source of pain is uncertain
- A patient wants temporary symptom relief while considering longer-term options
- The clinician needs to determine how much pain is truly coming from the joint
A steroid injection does not regrow cartilage or reverse arthritis. Relief, when it occurs, is temporary and varies from person to person.
Suspected labral tear or femoroacetabular impingement
Patients with labral pathology or femoroacetabular impingement may report groin pain, catching, clicking, stiffness, or pain with deep flexion and rotation.
An injection containing local anesthetic can sometimes help answer a diagnostic question. If the patient’s usual pain improves substantially while the joint is numb, that supports the hip joint as an important pain source. It does not, by itself, prove that every MRI finding is symptomatic or that surgery is required.
The international Warwick Agreement emphasizes that femoroacetabular impingement syndrome requires symptoms, clinical signs, and imaging findings together. Imaging findings alone are not enough. Read the Warwick Agreement.
Greater trochanteric pain syndrome and bursitis
Pain on the outside of the hip may come from the gluteus medius or minimus tendons, a bursa, or both. An ultrasound examination can help identify the likely target.
A bursal injection may reduce pain when inflammation is preventing sleep or participation in physical therapy. However, repeated injections without addressing tendon weakness, compression, gait mechanics, or a tendon tear may provide only temporary relief.
Read our detailed guide to outer hip pain and gluteal tendon problems.
Iliopsoas tendon or bursa pain
Pain in the front of the hip can arise from the iliopsoas tendon or bursa. This may occur in athletes, after hip surgery, or with certain movement patterns. A targeted injection may be used diagnostically or therapeutically after the examination and imaging support that diagnosis.
Hamstring, adductor, or other tendon-related pain
Not every painful tendon should be injected, and corticosteroid should be used cautiously around tendons. The exact diagnosis and tissue quality matter. Some tendon problems are best treated with load modification and progressive strengthening rather than an injection.
Diagnostic injection versus therapeutic injection
These terms are related but not identical.
Diagnostic injection
A diagnostic injection usually contains local anesthetic. The goal is to temporarily numb a specific structure and observe whether the patient’s typical pain changes.
A useful diagnostic result depends on testing the activities that normally reproduce symptoms. For example, the patient may walk, climb stairs, squat, sit, or perform a controlled movement before and after the injection.
A diagnostic injection can help separate:
- Hip-joint pain from lumbar spine pain
- Intra-articular pain from lateral tendon pain
- Pain caused by arthritis from pain caused by another nearby structure
- A meaningful MRI finding from an incidental finding
The result is one piece of evidence, not a standalone verdict.
Therapeutic injection
A therapeutic injection is intended to reduce symptoms. It may contain corticosteroid, local anesthetic, or another selected substance depending on the diagnosis.
The best use of symptom relief is often to help the patient move, sleep, and participate in rehabilitation. An injection should usually be part of a broader plan rather than the entire plan.
What medications may be used?
Local anesthetic
Local anesthetic provides temporary numbness and may help determine whether the targeted structure is contributing to pain. The effect typically lasts hours rather than weeks.
Corticosteroid
Corticosteroid can reduce inflammation and may provide short-term relief. It does not repair a torn tendon, restore cartilage, or correct hip mechanics.
Potential concerns include:
- Temporary pain flare
- Temporary elevation in blood sugar
- Skin or fat changes at superficial injection sites
- Infection, although uncommon
- Bleeding or bruising
- Tendon weakening if injected into or repeatedly around vulnerable tendon tissue
- Possible joint-related risks with repeated exposure
The decision should consider diabetes, blood thinners, infection risk, upcoming surgery, previous injections, and the specific target.
Hyaluronic acid
Hyaluronic acid is not recommended by the AAOS for symptomatic hip osteoarthritis because high-quality evidence has not shown better outcomes than placebo.
Platelet-rich plasma
PRP is an evolving option for selected hip conditions, but evidence varies by diagnosis. PRP should not be described as a guaranteed cartilage or tendon regeneration treatment.
For hip osteoarthritis, study results are mixed and protocols differ. For tendon-related pain, patient selection, tear severity, injection target, and rehabilitation remain important. Learn more about regenerative medicine options.
What happens during an ultrasound-guided hip injection?
The exact steps depend on the target, but a typical procedure includes:
- Review of the diagnosis, medications, allergies, and procedure plan
- Positioning on the exam table
- Ultrasound examination to identify the target and nearby structures
- Cleaning the skin with antiseptic solution
- Use of sterile gel, probe cover, and supplies as appropriate
- Local numbing medication when needed
- Real-time ultrasound visualization as the needle advances
- Injection of the selected medication
- A brief observation period and post-procedure instructions
Most patients feel pressure, a pinch, or temporary soreness. The procedure is usually completed in the office.
How should I prepare?
Before the appointment, tell the clinical team about:
- Blood thinners or bleeding disorders
- Diabetes
- Medication allergies
- Fever, infection, antibiotics, or open skin wounds
- Pregnancy or possible pregnancy
- Previous reactions to injections
- Recent or planned surgery
- The exact location and activities that reproduce pain
Do not stop prescription blood thinners unless the prescribing clinician and procedural clinician give specific instructions.
Wear clothing that allows access to the hip while maintaining appropriate draping and privacy.
What should I expect afterward?
After the injection:
- The hip may feel numb or temporarily different for several hours
- Pain may briefly improve from local anesthetic
- A steroid flare can cause soreness for a day or two
- Blood sugar may rise temporarily in patients with diabetes
- Strenuous activity is often limited for a short period
- A symptom diary can be helpful after a diagnostic injection
Patients should receive instructions tailored to the medication and target. Contact the office promptly for increasing redness, drainage, fever, severe swelling, progressive weakness, or rapidly worsening pain.
How long does relief last?
There is no single answer.
Relief depends on:
- The accuracy of the diagnosis
- The structure injected
- The medication used
- The severity of arthritis or tissue damage
- Whether the pain is coming from more than one source
- Activity demands
- Participation in rehabilitation
For hip osteoarthritis, corticosteroid injections are best viewed as a short-term symptom-management option. They are not a permanent solution and should not automatically be repeated whenever pain returns.
Can an injection delay hip replacement?
An injection may temporarily reduce symptoms, but it does not reverse advanced arthritis. Some patients use an injection to manage a flare or gain time before surgery. Others find the benefit too brief to justify repeating it.
When pain, stiffness, sleep disruption, and loss of function remain severe despite reasonable nonsurgical treatment, it may be appropriate to discuss hip replacement rather than continuing a cycle of temporary injections.
The timing of an injection before joint replacement also matters because surgeons may recommend avoiding intra-articular corticosteroid injections within a defined period before surgery. That decision should be coordinated with the operating surgeon.
Dr. Morton’s perspective
Ultrasound is valuable because it improves precision and gives immediate information about the anatomy. But the technology is only useful when paired with a thoughtful diagnosis.
A well-planned injection should have a clear purpose:
- Confirm the likely pain source
- Reduce a flare enough to participate in therapy
- Target a specific bursa or tendon region
- Provide temporary relief while a larger treatment decision is made
If the injection does not help, that information is also useful. It may mean the wrong structure was targeted, the condition is too advanced for an injection to provide meaningful relief, or another source such as the spine is contributing.
Ultrasound-guided hip care in Hawai‘i
Pacific Bone & Joint evaluates hip arthritis, labral and impingement symptoms, lateral hip pain, tendon disorders, sports injuries, and persistent pain after prior treatment. Care is available in Honolulu, Waipahu, Hilo, and Kona by appointment.
Evaluation may include examination, X-rays, musculoskeletal ultrasound, MRI review, physical therapy, image-guided injection, regenerative medicine discussion, or surgical consultation when appropriate.
Call (808) 439-6201 to request an appointment.
This article is educational and does not replace an individualized examination.
Sources and further reading
- American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Hip: Updated Clinical Practice Guideline. AAOS. 2024.
- Kolasinski SL, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research. 2020.
- Hoeber S, et al. Ultrasound-Guided Hip Joint Injections Are More Accurate Than Landmark-Guided Injections: A Systematic Review and Meta-Analysis. British Journal of Sports Medicine. 2016.
- Uson J, et al. EULAR Recommendations for Intra-Articular Therapies. Annals of the Rheumatic Diseases. 2021.
- Griffin DR, et al. The Warwick Agreement on Femoroacetabular Impingement Syndrome: An International Consensus Statement. British Journal of Sports Medicine. 2016.
- Huang Z, et al. Effectiveness of Ultrasound Guidance on Intra-Articular and Periarticular Joint Injections: Systematic Review and Meta-Analysis of Randomized Trials. American Journal of Physical Medicine & Rehabilitation. 2015.
