Home Training, Local Corticosteroid Injection, or Radial Shock Wave Therapy for Greater Trochanter Pain Syndrome
- 13 May 2009
- journal article
- research article
- Published by SAGE Publications in The American Journal of Sports Medicine
- Vol. 37 (10), 1981-1990
- https://doi.org/10.1177/0363546509334374
Abstract
Background 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 sequentially 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 significantly better than those after home training (7%; 5.9 points) or shock wave therapy (13%; 5.6 points). Regarding treatment success 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 corticosteroid 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.This publication has 22 references indexed in Scilit:
- Radial Extracorporeal Shock Wave Therapy is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar FasciitisThe American Journal of Sports Medicine, 2008
- Correlation of MRI findings with clinical findings of trochanteric pain syndromeSkeletal Radiology, 2008
- ILIOTIBIAL BAND Z-LENGTHENING FOR REFRACTORY TROCHANTERIC BURSITIS (GREATER TROCHANTERIC PAIN SYNDROME)Anz Journal of Surgery, 2007
- Effect of corticosteroid injection for trochanter pain syndrome: design of a randomised clinical trial in general practiceBMC Musculoskeletal Disorders, 2007
- Arthroscopic Bursectomy With Concomitant Iliotibial Band Release for the Treatment of Recalcitrant Trochanteric BursitisArthroscopy: The Journal of Arthroscopic & Related Surgery, 2007
- Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trialBMJ, 2006
- Evidence-Based Soft Tissue RheumatologyJCR: Journal of Clinical Rheumatology, 2004
- Statistics notes: Multiple significance tests: the Bonferroni methodBMJ, 1995
- A CLINICAL EPIDEMIC-LOGICAL STUDY IN LOW BACK PAIN. DESCRIPTION OF TWO CLINICAL SYNDROMESRheumatology, 1990
- Trochanteric Bursitis:Treatment by Corticosteroid InjectionScandinavian Journal of Rheumatology, 1985