Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome.pdf
AJSM PreView, published on May 13, 2009 as doi:10.1177/0363546509334374 Home Training, Local Corticosteroid Injection, or Radial Shock Wave Therapy for Greater Trochanter Pain Syndrome
Jan D. Rompe,*† MD, Neil A. Segal,‡ MD, Angelo Cacchio,§ MD, John P. Furia,ll MD, Antonio Morral,¶ PT, and Nicola Maffulli, MD, MS, PhD, FRCS(Orth), FFSEM(UK)From the †OrthoTrauma Evaluation Center, Mainz, Germany, ‡Department of Orthopaedics & Rehabilitation, University of Iowa, Iowa City, Iowa, §Dipartimento di Medicina Fisica e Riabilitazione, Ospedale “San Salvatore” di L’Aquila, L’Aquila, Italy, llSUN Orthopaedics, Lewisburg, Pennsylvania, ¶Centre de Fisioteràpia Salut i Esport (Sta. Perpètua), EUIFN Blanquerna, Barcelona, Spain, and Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, London, United KingdomBackground: There are no controlled studies testing the efficacy of various nonoperative strategies for treatment of greater trochanter pain syndrome. Hypothesis: The null hypothesis was that local corticosteroid injection, home training, and repetitive low-energy shock wave therapy produce equivalent outcomes 4 months from baseline. Study Design: Randomized controlled clinical trial; Level of evidence, 2. Methods: Two hundred twenty-nine patients with refractory unilateral greater trochanter pain syndrome were assigned sequen- tially to a home training program, a single local corticosteroid injection (25 mg prednisolone), or a repetitive low-energy radial shock wave treatment. Subjects underwent outcome assessments at baseline and at 1, 4, and 15 months. Primary outcome measures were degree of recovery, measured on a 6-point Likert scale (subjects with rating completely recovered or much improved were rated as treatment success), and severity of pain over the past week (0-10 points) at 4-month follow-up. Results: One month from baseline, results after corticosteroid injection (success rate, 75%; pain rating, 2.2 points) were signifi- cantly better than those after home training (7%; 5.9 points) or shock wave therapy (13%; 5.6 points). Regarding treatment suc- cess at 4 months, radial shock wave therapy led to significantly better results (68%; 3.1 points) than did home training (41%; 5.2 points) and corticosteroid injection (51%; 4.5 points). The null hypothesis was rejected. Fifteen months from baseline, radial shock wave therapy (74%; 2.4 points) and home training (80%; 2.7 points) were significantly more successful than was cortico- steroid injection (48%; 5.3 points). Conclusion: The role of corticosteroid injection for greater trochanter pain syndrome needs to be reconsidered. Subjects should be properly informed about the advantages and disadvantages of the treatment options, including the economic burden. The significant short-term superiority of a single corticosteroid injection over home training and shock wave therapy declined after 1 month. Both corticosteroid injection and home training were significantly less successful than was shock wave therapy at 4-month follow-up. Corticosteroid injection was significantly less successful than was home training or shock wave therapy at 15-month follow-up. Keywords: trochanteric pain; greater trochanter pain syndrome (GTPS); trochanteric bursitis; corticosteroid injection; stretching; shock wave therapy
A frequent but often overlooked painful overuse syndrome of
*Address correspondence to Jan D. Rompe, MD, Chief, OrthoTrauma
Evaluation Center, Oppenheimer Str. 70, D-55130 Mainz, Germany
the hip in adults engaging in recreational sports activities is
commonly called trochanteric bursitis. The anatomical rela-
No potential conflict of interest declared.
tionship between 3 bursae, the hip abductor-external rotator muscles, the greater trochanter, and the overlying iliotibial
The American Journal of Sports Medicine, Vol. X, No. X
tract may predispose this area to biomechanical irritation.
DOI: 10.1177/0363546509334374 2009 The Author(s)
The name trochanteric bursitis suggests inflammation in
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