Which method is MOST definitive to confirm a diagnosis of trochanteric bursitis?

• A. Diagnostic injection
• B. Ultrasonography
• C. Bone scan
• D. X-ray

Answer: (A)

The way to definitively confirm trochanteric bursitis is to test the specific source of pain by injecting the trochanteric bursa with a local anesthetic. If the patient's lateral hip pain is rapidly and markedly relieved after the injection, it confirms that the bursa is the pain generator. This functional test directly demonstrates whether the bursa is responsible for the symptoms, which imaging alone cannot do.

Imaging studies like ultrasonography can show bursal fluid or thickening, but such findings don’t prove that the bursa is causing the pain—many people with bursitis-like changes may be asymptomatic or have pain from other structures. X-ray evaluates bone and joint alignment but not soft tissue inflammation. Bone scans look at bone metabolism and aren’t specific for soft-tissue bursitis. Therefore, the diagnostic injection provides the clearest confirmation by reproducing or removing the pain source in real time.