Comparison of fluoroscopically guided and blind corticosteroid injections for greater trochanteric pain syndrome: multicentre randomised controlled trial.
OBJECTIVE
To determine whether fluoroscopic guidance improves outcomes of injections for greater trochanteric pain syndrome.


METHODS
Multicentre double blind randomised controlled study.


METHODS
Three academic and military treatment facilities in the United States and Germany.


METHODS
65 patients with a clinical diagnosis of greater trochanteric pain syndrome.


METHODS
Injections of corticosteroid and local anaesthetic into the trochanteric bursa, using fluoroscopy (n=32) or landmarks (that is, "blind" injections; n=33) for guidance.


METHODS



METHODS
0-10 numerical rating scale pain scores at rest and with activity at one month (positive categorical outcome predefined as >or=50% pain reduction either at rest or with activity, coupled with positive global perceived effect). Secondary outcome measures included Oswestry disability scores, SF-36 scores, reduction in drug use, and patients' satisfaction.


RESULTS
No differences in outcomes occurred favouring either the fluoroscopy or blind treatment groups. One month after injection the average pain scores were 2.7 at rest and 5.0 with activity in the fluoroscopy group compared with 2.2 and 4.0 in the blind injection group. Three months after the injection, 15 (47%) patients in the blind group and 13 (41%) in the fluoroscopy group continued to have a positive outcome.


CONCLUSIONS
Although using fluoroscopic guidance dramatically increases treatment costs for greater trochanteric pain syndrome, it does not necessarily improve outcomes.


BACKGROUND
Clinical trials NCT00480675.
Cohen
Steven P
SP
Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA. scohen40@jhmi.edu
Strassels
Scott A
SA
Foster
Leslie
L
Marvel
John
J
Williams
Kayode
K
Crooks
Matthew
M
Gross
Andrew
A
Kurihara
Connie
C
Nguyen
Cuong
C
Williams
Necia
N
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D005269:Femur; D005471:Fluoroscopy; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D015641:Radiography, Interventional; D013577:Syndrome; D016896:Treatment Outcome; D055815:Young Adult
D000305:Adrenal Cortex Hormones